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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWSE-2.1 <br />MBEMBE CONTACTED <br />This Completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBENVBE 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 OF <br />Project Number: 117-025 MBEIWBE Participation Goal <br />Project Name: Wastewater Treatment Plant Belt Filter Press #4 Rehabilitation <br />Bidder: industrial Maintenance and Contract Services, L.P. <br />By: FORM NIA. PARTICIPATION GOAL IS MET. <br />(Signature) (Till e) (Date) <br />MBEIWBE Firm <br />Owner or Contact at MBEIWBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBENVBE FIRM: <br />MBEANBE Firm <br />Owner or Contact at MBENUBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBENIBE FIRM: <br />Version 10/17/2016 Contractor's Bid for Public Works -10 <br />