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CITY OF SOUTH BEND ?�9�urir.$, <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY A. <br />DEVELOPMENT PROGRAM s <br />FORM MWBE-2 f <br />MBEIWBE CONTACTEDI ,.r <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />requiring contacted MBEfWBE 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 I OF <br />Project Number: 117.092 MBENVBE Participation Goal <br />P,oJo61Na Leighton Deck Coatings - Phase II <br />Bidder: RA Construction Services of Michigan, Inc. <br />By: % Robert T. Mazur, President . December 12, 2017 <br />(Signature) (Title) (Date) <br />MBENVBE Firm *RAM is Self Performing All work* <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 MBEA BE FIRM: <br />MBENVBE Firm <br />Owner or Contact at MBE/WBE Firm <br />Telephone: Fax: Email: <br />TYPE OF WORK SOLICITED "'FOR THIS PROJECT: <br />RESULTS OF CONTACT WITH THE MBENVBE FIRM: <br />Version 10/17/2016 Contractor's Bid for Public Works -10 <br />