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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY �,rtif <br />DEVELOPMENT PROGRAMS'"` ° <br />FORM MWBE-2.1„ <br />MBE/WBE CONTACTED::,.yis"asF> <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify <br />whether any listed minority or woman business meets the qualifications of a Minority or Women's owned <br />business. <br />Project Number: 116-127A <br />Project Name: <br />Bidder: <br />By: �( <br />(Signature) <br />PAGE i OF <br />MBE/WBE Participation Goal /J/A <br />Sheridan Street and Sample Street Signal Improvements <br />MBE/WBE Firm —40 0 fe Cha ✓✓1 e 14 <br />Owner or Contact at MBE/WBE Firm <br />(Title) <br />(Date) <br />vao <br />Telephone:( -57q). 97—:2 1$Fax: (S7y)�87-/'c/4/Email:) <br />/c��e'r�t�F P aoj>Oorn <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: M ��� Trc,t 1� C <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: 6(p— will rlj V ►t� �� `i'Ir�C. i t Ioi C� <br />MBE/WBE Firm <br />Owner or Contact at MBE/WBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />Version 4/2/2019 Contractor's Bid for Public Works - 12 <br />