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tip0 ll/ y <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY, <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 ' <br />MBE/WBE 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: 120-036 Project Name: WWTP Masonry Improvements Gallery Buildings 1-4 <br />Bidder: <br />Slatile Roofing and Sheet Metal Co., INC. Total Bid Amount: $420,218.00 MBE/WBE Goal: <br />Paae of <br />Name &Address of MBE/WBE <br />Primary Contact Person <br />Name/Tele hone ( p ) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of <br />MBENVBE Component <br />Percentage <br />of TotalBid/Proposal <br />Submitted by: Gerald Longerot - President <br />Print Name <br />Signature <br />Version 4/2/2019 Contractor's Bid for Public Works - 9 <br />10/12/2020 <br />Date <br />