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CITY OF SOUTH BEND o��a <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBE/WBE PARTICIPATION r <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects Involving MBEIMBE 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: <br />Bidder: <br />9-043 Project Name: <br />Rieth-Riley Construction Co., Inc. <br />Gemini Sit Im rovem nts <br />Total Bid Amount: 9�0 00 MBE/WBE Goal: N/A <br />Pane I rsf I <br />Name A. Address of MBENVBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />P <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of <br />MBE/MBE Component <br />MJ <br />Veda Godette <br />V & R Trucking <br />574-234-1268 <br />Trucking <br />133 9 9.sso <br />S �% <br />Submitted by: Josh McCormick - Sales Manager <br />Print Name re <br />Version 4/2/2019 Contractor's Bid for Public Works - S <br />Date <br />6/11/2019 <br />