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CITY OF SOUTH BEND 41." <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-2.1 <br />MBEIW13E CONTACTED <br />This, completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBE/WBE to obtain Good Faith Efforts. It Is the bidder's sole responsibility to verify <br />whether any listed minority or woman business meets the qualifications of a Minority or Women's owned <br />business. <br />PAGE 3 OF 3 <br />Project Number: 1 1'7-072A MBE/WBE Participation Goal <br />Project Name: Lincoln Way West and' Charles Martin Sr. Drive Improvements <br />Bidder: Selge QQnstruction Co., Inc. <br />Robert Kuhns, Project Engineer 6/12/18 <br />(Signature) (Title) (Date) <br />MBE/WBE Firm Bancroft Electric y0B <br />Owner or Contact at MBE/WBE Firm Kieth Bancroft <br />Telephone: 21'9-326-8,090 Fax: 219-326-5216 Email: michele@bancroftelectric.net <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />Electrical <br />RESULTS OF CONTACT WITH THE MBEMBE FIRM: <br />Ouc)te Ac --- 4--A <br />MBEANBE Firm <br />Owner or Contact at MBE/WBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBEANBE FIRM: <br />Version 10/17/2016 Contractor's Bid for Public Works - 13 <br />