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CITY OF SOUTH BEND oF6ou�N°Qta� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBEIWBE PARTICIPATION rbas - <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE/MBE 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: 118-058 Project Name: Great Lakes Capital Spec Building, 5545 Chet Waggoner Court Paving <br />Bidder: Walsh & Kelly, Inc. Total Bid Amount: $447,834.20 MBEIWBE Goal: .0044% <br />Page 1 of 1 <br />Name &Address of MBENJBE <br />Primary Contact Person <br />(Namelrelephone) <br />Scope of Work to be Performed <br />(A(lach scopelschedule if you need additional space} <br />Dollar Amount of <br />MBEIWBE Component <br />Percentage <br />of Total <br />BidlPro osal <br />V&R Trucking, Inc. <br />Veda Godette <br />Hauling - Partial <br />$1,000.00 <br />1845 North Elmer Street <br />574-234-1268 <br />.0022% <br />South Bend, IN 46628 <br />C. Lee Construction <br />Services, Inc. <br />Chip Lee <br />219-922-7733OD22/o <br />- HaulingPartial <br />$1,000.00 <br />0 <br />1011 S. Lake Street <br />Gary, IN 46403 <br />Submitted by: Dustin Hilary, VP of South Bend Area 9/26/18 <br />Print Name Si at �a Date <br />Version 7/20/2018 contractor's Bid for Public Works - B �y OR A ] <br />� �A <br />