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k"k4! WN r <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM" <br />FORM MWBE-2.1' <br />µ <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 />Project Number: 11 <br />Project Name, <br />Bidder: VV <br />By: <br />Center p!kin Lot <br />Kelly, Inc. <br />re) Dustin Hilary <br />PAGE, 1 OF <br />MBE/WBE Participation Goal <br />a'teway Improvements <br />VP of South Bend Area 9/24/19 <br />(Title) <br />'BE Firm State Barricading, Inc. <br />or Contact at MBE/WBE Firm James Michalski <br />(uate) <br />Telephone: 574-287-2078 Fax: 574-287-1744 Email: STATE BAIR R I CADE 1-_DJ&om <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />Control Devices <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />We will use State Barricading, Inc. if we are awarded the project. <br />MBE/WBE Firm <br />Owner or Contact at MBE/WBE Firm <br />Telephone: <br />Fax: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Email: <br />Version 4/2/2019 Contractor's Bid for Public Works - 11 <br />