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CITY OF SOUTH BEND � <br />�41 <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <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: 117-108 Project Name: Airport Annexation Area Sanitary Sewer Extension <br />Bidder: H R P CONSTRUCTION INC. Total Bid Amount: MBENME Goal: <br />_................. _ _........._...._ Page 1 of <br />Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage <br />Name &Address of MBElWBE Namerrele hone ( p ) (Attach scope/schedule if you need additional space) MBEANBE Component of TotalBid/Pro oral <br />5lusser's Green Thtmb <br />P.O. Box 33 John William on Seeding <br />Logansport, IN 800-762-7442 28,800.00 <br />46947 <br />State Barricading James Michb ski <br />P.O. Box 3751 Traffic Control 5,000.00 <br />South n.? _IN466119574-287-207'3 <br />...... ......... ..._..... <br />Submitted by: Matthew D. Cain, Presiden November 27,,ITIT-201,8m <br />Print Name Signature Date <br />Version 7/20/2018 Contractor's Bid for Public Works- 9 <br />