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CITY OF SOUTH BENIJ <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1,O „r< <br />M13E1WBE PARTICIPATION 1 ^ V <br />t�•'y.�lN65' ,. is . <br />This completed form should be supplied with Bids that pertain to City of South 11Bend Public Works Projects invotvinr� MBEflV36E participation, <br />o is the bidder's sole responsibility to verifywhether any listed minority orwoman business meets the qualifications of a Minority or Women's <br />owned business. <br />Project Number; 117-1OOR Project Name: Lafa Otte Building Exterior Renovation <br />Bidder: N1,4 Total Bid Amount: <br />� MBENWBE Goal: <br />Submitted by: STEVE FIELDS <br />Print Name 5tgnaiure e 10/8/2018 <br />Date <br />Version 7/2012018 Contractor's Bid for Public Works - 9 <br />