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CITY OF SOUTH SEND <br />MINORITY AND WOMEN! BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />;V <br />FORM MWBE-1.0 <br />PROOF OF MBEIWBE PARTICIPATION GOAL <br />his completed form Should be supplied with Bids that pertain to, City of South Bond Public Works Projects requiring proof of MSEIMBE <br />articipation goal. It Is the bidder's sole responsibility to verify whether any listed minority or woman business meets thoquallfications of a <br />Inorhy or Women's owned business. <br />Project Number. 117.0838 _ Project Name: Offslte.Parkingi Lot at Wayne St. and St. Louis Boulevard <br />Bidder: Rieth-Riley Construction Total Bid Amount: $ 379,986,95 MBEWBEGoaji 7.1% <br />Paga_L_o( I <br />Nwa, & Address of FMEWIE <br />Primary contact Pffew <br />(Nsrnw*t*4ptw*) <br />SCOPe of Work W be Pwfomed <br />(Mach -oW-hadrAa V you n*W &&M-W sp-) <br />DO AMO.A of <br />MBF/MF-Cmnpmwt <br />PWOWY&O <br />of TOW <br />DBL Services Inc, <br />1811 N Clover Rd. <br />Dave Letch!er <br />Striping & Landscaping <br />$17,354.75 <br />4.56% <br />Mishawaka, ln 46545 <br />574-968-2028 <br />V&R Trucking <br />Veda <br />1845 North Elmer St.. <br />574-234-126E <br />Trucking <br />South Benid, In,46628, <br />$ 8,0100.00 <br />2,1% <br />Master Enterpdses <br />Darrin L. Orr <br />317-545-3335, <br />Matedal Supplier <br />!$ 2,939,66 <br />.5% <br />8ubmittedby: Joshua A. McCormick July 10, 2018 <br />Print Name Date <br />Version 10/1712010 Contractor's 8W for Public Vib*s - P <br />