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CITY OF SOUTH BEND <br />o j uT,`Eryri <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />I u Imo` <br />FORM MWBE-1.0 <br />,3, '• _'� <br />MBElWBE PARTICIPATION <br />lets_. <br />�- <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: 118-07/4 A , Project Name: Three Twenty at the Cascade -- Glazed Assemblies <br />Bidder: t �iL1 �I (J('i,� {� 'h C , Total Bid Amount: F J 7 MBE/WBE Goal: <br />Page of <br />Name & Address of MBE MBE <br />Primary Contact Person <br />(Namerrelephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />DollarAmount of <br />MBENYBE Component <br />Percentage <br />OfTotal <br />Bid/Proposal <br />a <br />pp <br />4 <br />4 <br />Submitted by: �� [.�� ;� �"" /® �,&), 1, <br />Print Namb Signature 4Dale <br />Version 7/20/2018 Contractor's Bid for Public Works - 8 <br />