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v �r <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY A <br />DEVELOPMENT PROGRAM is <br />FORM MWBE-2.1°`��°" <br />MBENVBE CONTACTED' <br />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 1 OF 1 <br />Project Number: 118-097 MBENVBE Participation Goal 0% <br />Project Name: Ewina Avenue and Fellows Street Intersection Traffic Signal <br />Bidder: ylicNana Contracting Inc <br />By: ( Scott Kirkpatrick, President 11/12/19 <br />(Title) (Date) <br />MBE/WBE Firm Premium Concrete Services <br />Owner or Contact at MBENVBE Firm Rob Becker <br />Telephone: 574-264-0196 Fax: 574-612-3709 <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />Concrete services <br />RESULTS OF CONTACT WITH THE MBENVBE FIRM: <br />Email: rbecker@premiumconcreteonline.com <br />Received and accepted quote from Premium Concrete Services <br />MBENVBE Firm <br />Owner or Contact at MBENVBE Firm <br />Telephone: <br />Fax: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBENVBE FIRM: <br />Email: <br />Version 1/17/2019 Contractor's Bid for Public Works - 11 <br />