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_..,...e....... -— <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBEIWBE PARTICIPATION"s <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE/MBE 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. 11.0241 Project Name Kizer Mansion Window Repair <br />aITIT mm mmm_ <br />Bidder: TotlBid Amount: MBE/WE Goal: <br />I; - <br />Page —of m w ITIT.IT._._ITITITITmm <br />Name 8 Address of MBEM/BE <br />Primary Contact Person <br />Scope of Work to be Performed <br />�.. _....._._.... <br />Dollar Amount of <br />_................_..... .... <br />Percentage <br />of Total <br />(NamerTelephone) <br />(Attach scope/schedule if you need additional space) <br />MBEM/BE Component <br />Bid/Pro osal <br />�.... <br />l <br />................. <br />. ................................. <br />l <br />Submitted by; <br />Version 7/20/2018 <br />Contractor's Bid for Public Works - 8 <br />Date E' <br />