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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-2.0 <br />EVIDENCE OF GOOD FAITH EFFORTS <br />tt Ttlp �.. <br />CS6N.= <br />This completed on. should be <br />supplied <br />with Bids that pertain <br />to City of South Bend <br />Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility <br />to verify <br />whether any listed woman -owned business <br />meets the WBE qualifications. <br />Project Number: 122-049 Project Name: Cleveland Road and Ameritech Drive Intersection Improvements <br />x> <br />Bidder: Premium Concrete Services Inc. Total Bid Amount: S/ 7 32/� WBE Goal: 5.64% <br />PagePageL. 1 of 1 <br />Name &Address of WBE <br />Primary Contact Person <br />Scope of Work to be re, ormed <br />Dollar Amount of WBE <br />Percentage <br />of Total <br />(Name/Telephone) <br />(Attach scope/schedule if you need additional space) <br />Component <br />Bid/Proposal <br />State Barricading <br />James Michalski <br />Maintenance Traffic, Temp Striping <br />h CIO <br />�() OCo <br />4. <br />24963 US 20 West <br />(574) 287-2078 <br />of <br />3 . <br />South Bend, IN 46628 <br />Hawk Enterprises Inc. <br />Caylee Carlson <br />(269) 662-8093 <br />Traffic Signaling <br />10 <br />g <br />1850 E. North St. <br />Crown Point, IN <br />Submitted by: <br />Austin Redding <br />Print Name <br />818/23 <br />Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 10 <br />