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�L1 P g <br />CITY OF SOUTH BEND." <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY,; <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBE/WBE PARTICIPATION 186� <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: 120-036 Project Name: <br />Bidder: Beralund Construction Companv <br />WWTP Masonry Improvements Gallery Buildings 1-4 <br />Total Bid Amount: $750 <br />MBE/WBE Goal: <br />Page 1 of 1 <br />Name & Address of MBE/WBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of <br />MBE/WBE Component <br />Percentage <br />of Total <br />Bid/Proposal <br />See attached letter of <br />Good Faith Efforts <br />Submitted by: <br />Jack Tribbia <br />Print Name <br />m° October 13, 2020 <br />Signature Date <br />Version 4/2/2019 Contractor's Bid for Public Works - 9 <br />