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CITY OF SOUTH BENDwrcarxrw <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM iu <br />FORM MWBE-1.0 <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 />. ry Remodel <br />Center — South Bend, Lower l evel Restroom <br />Project Number: Project Name: Centu <br />Bidder: ��tal Bid Amount: MBENVBE Goal: <br />Page of <br />Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage <br />Name 8 Address of MBEIWBE ... p ( P o. of Tolal-^ <br />(Name(rele hone Attach scope/schedule If you need additional space) MBEIWBE Com of „e <br />AU SCi11,I -+P�pi <br />C <br />4 <br />Submitted by: <br />5 <br />1�n R ham Me <br />Version 7/20/2018 Contractor's Bid for Public Works - 20 <br />