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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 />PAGE 1 OF 1 <br />Project Number, 116 d83D MBE/WBE Participation Goal 7.1% <br />Project Nam€: andolph Street Basin Emergency Repair <br />Bidder:. Ish &,}Sefly Inc. <br />By:, Dustin Hilary, Area Manager October 20, 2016 <br />/(Signature) (Title) (Date) <br />MBENVBE Firm <br />Owner or Contact at MBENVBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBE/WBE FIRM: <br />MBENVBE Firm <br />Owner or Contact at MBENVBE Firm <br />Telephone: Fax Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBENVBE FIRM: <br />Version 7/28/2016 Contractor's Bid for Public Works - 27 <br />