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CITY OF SOUTH SEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />K ? <br />DEVELOPMENT PROGRAM <br />FORM MWBE-11.0 <br />MBEfWBE PARTICIPATION <br />Igo <br />This completed form Should be supplied with Bids that pertain to City of South Bend Public Works Projects Involving MBEIMBE participation. <br />It Is the bidder's sole responsibility to verify whether any listed minority orwoman business meets the qualifications of a Minority or Women's <br />owned business. <br />Project Number; 11"68 _ Project Name: Great Lakes Capital $Poe Building, 5645 Chat Waggoner Court Paving <br />Bidder Rieth-Riley Construction Co., inc. Total Bid Amount MBEMBE Goal: n/a <br />Page —L—of <br />Name & Address of MOEMBE <br />Primary Contact Person <br />(Narnerrelephone) <br />Scope of Work to be Performed <br />(Allaeb scope/schedute, if you need additional space) <br />Doilar Amount of <br />MSE�ANBE Component <br />Percentage <br />MUM <br />Bid/P(geosol <br />Submitted by: Joshua A, McCormick, Sales Manage September 25, 2018 <br />Print INarme Signet Date <br />Version 7120/2018 Contractors Bid for Public Works - 8 <br />