Laserfiche WebLink
CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />t a� <br />WBE PARTICIPATION <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE/MBE <br />It <br />participation. <br />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: 120-044 �'roject-Name: Ignition Park: EV Charging Park <br />Bidder: Larson _Danielson Total Bid Amount: WBE:Goal: <br />4.2% <br />Construction Company, Inc. <br />Page 1 <br />of 1 <br />Name & Address of MBE/WBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />Dollar Amount of <br />Percentage <br />(Attach scope/schedule if you need additional space) <br />MBE/WBE Component <br />of Total <br />Bid/Proposal <br />Timothy F. Larson X'-'— <br />Submitted by:. , 3/9/21 <br />Print Name Signature, Date - <br />Version 41 019 ��.�;. LARSON DANIELSON <br />Contractor's Bid:for Public Works - <br />SEgL <br />>.�A NSTRUCTIOIV CO., INC, <br />