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This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBEtWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify <br />whether any listed minority or woman business meets the qualifications of a Minority or Women's owned <br />business. <br />PAGE 2 OF 2 <br />Project Number: 119-022 MBE/WBE Participation Goal <br />Project Name: Main & Jefferson Earthwork <br />Bidder: Bely Construction„ inc. <br />By: President M� <br />(Title) <br />MBE/WBE Firm <br />Owner or Contact at MBENVBE Firm <br />Telephone; Fax: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBEM/BE FIRM: <br />Email: <br />MBENVBE Firm <br />Owner or Contact at MBENVBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />DEPARTMENT OF PUBLIC WORKS <br />CITY OF SOUTH BEND, INDIANA <br />Version 1/17/2019 Contractor's Bid for Public Works - 10 <br />r <br />9 <br />