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CITY OF SOUTH BEND�"� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-2.1 <br />MBE/WBE CONTACTED <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBE/WBE 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: 118-090 MBE/WBE Participation Goal <br />Project Name: Technology Resource Center <br />Bidder:r.rma+, r. a <br />By: <br />(Signature) (Title) (Date) <br />MBENVBE Firm <br />Owner or Contact at MBENVBE Firm', <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULT'S OF CONTACT WITH THE MBENVBE FIRM: <br />MBENVBE Firm <br />Owner or Contact at I <br />Telephone: ,° �—,— Fax: <br />TYPE OE WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBENVBE FIRM: <br />Email:, <br />Version 8/16/2018 Special Provisions - 12 <br />