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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBEIWBE PARTICIPATION <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: 119-103 Project Name: <br />Gemini at CoIf9jA ;�qrnp!21!� — EXTERIOR RENOVATIONS <br />Bidder: Bokon Masonry Inc. <br />................. . ... <br />Total Bid Amount: ...$4-18-,142.00 <br />MBE/WBE Goal: <br />-7-.-87% <br />Page 1 <br />of <br />Name & Address a MIEM11 <br />Primary Contact Person <br />I <br />Scope of Work to be Performed <br />Dollar Amount of <br />Percentage <br />of Total <br />(Narnerrelaph-- <br />one) <br />(Attach scope/schedule if you need additionalMBENVBE <br />Component <br />Scaffold Expres I Rick <br />2423 Huffmeiste Perlini <br />ypress,Texas i <br />Submitted by: „wwBokon <br />Print Name <br />Scaffolding for Canopy $3952.60 <br />Sidewalk protection <br />Version 4/2/2019 Contractor's Bid for Public Works - 9 <br />2/21/20 <br />