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CITY OF SOUTH BENDG <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM r <br />FORM MWBE-1.0 <br />MBElWBE PARTICIPATION <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Worlds Projects Involving MBSIMBE 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. Project Name we-.. air orlversion of offax Avenue — Phase it <br />RO o i f <br />Corr_ <br />St. Co. Inc. Total Bid Amount $ 673,873 00 MBEAAIBE Goal rN <br />_.� _....... <br />Page of� <br />-...-.-ess of t c ) (Attach acapel. ... Bia-A and <br />Primary Contact Person Scope of Work lobe Performed Dollar Amount of Pemanta9e <br />Name 6 Address d MBEANBE Name/Tele hone schedule dyau need additional space) MBEWSE Component of Total <br />._.......... ......... -- ....._. _.._.w,..�..�............�,..,._........_ .. w�. ,,_ <br />Hawk Enterprises Caylee Electrical 86,500.00 0 <br />1850 E. North St. Carlson 12/o <br />Crown Point, In. 219-662-8090 <br />Submitted by: Joshua A. McCormick November 28, 2019 <br />Print Name re "" _ . ... �., w._ ...Date <br />Version 4rJ2018 Contractor's Bid for Public Works - 13 <br />