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CITY OF SOUTH BENDarraa�,� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM W; <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 />Project Number: 118-066wwwwwwww ........ Project Name: Fat Dadoy's BWntrlitlon <br />&R Excavating,Inc. Total Bid Amount: See Itemized Bi �. E ...�E WW <br />Bidder: R <br />. d MBNVBGoal: <br />Page r of�_ <br />Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage <br />Name &Address of MBENVBE Name/Tele hone of Total <br />...............................µpal y .pace) MBEMIBE Component Bid/Proposal <br />p (Attach scope/schedule scheduled you need additional s � �. <br />State Barridading Jim Traffic Control $5892.00 <br />Machalski <br />Submitted by: Becky Blackston �� h.!�8 <br />Print Name S ature Date <br />Version 7/20/2018 Contractor's Bid for Public Works - 10 (Revised, Addendum No. 1) <br />