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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 MBEIWBE 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 OF <br />Project Number: 119-022 MBEMBE Participation Goal <br />Project Name: ain & Jefferson Edart work <br />r <br />Bidder: _0 1al) : "0� 1 <br />(Si nature) (Title) <br />(Date) <br />MBE/WBE Firm. <br />Owner or Contact at MBE/WBE Firm <br />Telephone: 6�y,7-Off— A Z,00 Fax: Z V yZ 4 2 3 Z Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: 40 <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />......... -- <br />1 44, 6 P `" �- CV <br />MBE/WBE Firm <br />Owner or Contact at MBE/WBE 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 />- <br />Version 1/17/2019 Contractor's Bid for Public Works - 10 <br />