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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 />TH <br />,�fFI <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />122-049 , Project Name: <br />Selge Construction Co., Inc. <br />Name & Address of WBE <br />State Barricading, Inc. <br />24963 US 20 West <br />South Bend, IN 46628 <br />Primary Contact Person <br />(Name/Telephone) <br />Esther Michalski <br />574-287-2078 <br />Cleveland Road and Ameritech Drive Intersection Improvements <br />Total Bid Amount: $ 1,639,630.15 WBE Goal: 5.64% <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Maintenance of Traffic <br />Page 1 of 1 <br />Dollar Amount of WBE Percentage l <br />of Total <br />Component <br />$144,261.20 1 8.80% <br />Submitted by: Justin Butler, Vice President 8.22.23 <br />Print Name Srgn re Date <br />Version 09/29/2021 Contractor's Bid for Public Works -10 <br />