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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: <br />Bidder: <br />117-093A Project Name: Seitz Park Reconstruction <br />Ziolkowski Construction, Inc. Total Bid Amount: <br />MBE/WBE Goal: <br />Page of <br />Name & Address of MBEIWBE <br />Primary Contact Person <br />(NamefFelephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />DollarAmount of <br />MBEM/BE Component <br />Percentage <br />of Total <br />Bid/Proposal <br />9A <br />2 <br />Submitted by: Kristin Kromer November 24, 2020 <br />Print Name ignaltury Date <br />Version 4/2/2019 Contractors Bid for Public Works - 21 <br />