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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAI <br />FORM MWBE-2.1 <br />MWBE CONTACTED <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring Good Faith Efforts to contact MWBEs. It is the bidder's sole responsibility to verify whether any listed <br />minority or woman business meets the MWBE qualifications. Attach additional pages, if necessary. <br />PAGE 2 OF. 2 <br />Project Number: 12 0-..01 MWBE Participation Goal <br />Project Name: 1201-Western Ave. Sidewalk Vault lie air <br />Bidder: John Boettcher Sewer & Excavating Contrac <br />tor <br />By: President 09/08/2020 <br />(Signature) (Title) (Date) <br />MWBE Firm Wilburn Construction <br />Owner or Contact at MWBE Firm <br />Telephone: 574-315-8288 Fax: 866-929-2137 Ernail: michellewilburn(a)_wccbuilds.com <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />Concrete <br />RESULTS OF CONTACT WITH THE MWBE FIRM: ProiectAqy.!q.,-not fit into their qw-rrenUche-du1e- <br />would not be able to bid <br />MWBE Firm <br />Owner or Contact at MWBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MWBE FIRM: <br />Version 2/14/2020 Page - 15 Public Works Quote <br />