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CITY OF SOUTH BEND 0 <br />� �1" rig ej <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM t"{ <br />FORM MWBE-1.61 <br />MBEIWBE PARTICIPATION <br />This completed form should be supplied with Bids that Pertain to City of South Bend Public Works Projects Involving MBEIMBE participation. <br />It Is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's <br />owned business. <br />Project Number: 11"46R Project Name: VPA Maintenance Storage Building <br />Bidder: � t)0C%� Total Bid Amount: �2/,,fg�,9- , G 2 MBEMBE Goal: <br />Page / off <br />Noma 8 Address of MBEA"lBE <br />Primary Contact Person <br />(NamelTelephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule If you need additional space) <br />Collar Amount of <br />MBEMd'BE Component <br />Percentage <br />of Total <br />BidNPro sal <br />n <br />,r, <br />il/; 1y 'hSlrrf <br />Iv"AOS <br />J�:4,i <br />Y, <br />plaG <br />6G� <br />3 9'�i7v�rr9 n ,%rd <br />� � a <br />S>p <br />Submitted by: Print me.,.-1— <br />a <br />Version 10117/2017 Contractor's Bid for Public Works - 9 <br />