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CITY OF SOUTH BEND <br />{y¢d r ar h <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM�4� <br />FORM MWBE-1.0 <br />0'al <br />MBE/WBE PARTICIPATION <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: 118-307 Project Name: 2018 Demolitions <br />Bidder: Ritschard Bros., Inc. Total Bid Amount:$3................................... �_......l...--7.----_-----. <br />6 .._.....�...��...���.�. ................ 1�....._� .� ............� 7. 1 <br />8 803 00 MBENVBE Goal• <br />Page 1 of 1 <br />��--Primary Contact Person (Attach scope/scheduleopofWork <br />If tobePerformed <br />Dollar <br />Amount of Purc�erN.'au8,r <br />Name & Address of MBEAVBE y need additional space} FIBE/WBE Component of Total <br />Ritsc lard Bros. , Inc. Rachelle L. <br />1204 W. Sample St. Dolniak Demolition $286, 773.0 89% <br />South Bend, IN 46619 574-288-4777 <br />submitted by: Rachelle L. Dolniak Novemb13 2018 <br />er ..........._............... l rgature <br />Print Name �— ........__._....,�.................................. <br />Date <br />Version 7/20/2018 Contractor's Bid For Public Works - 10 <br />