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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 MBEIWBE 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 />Project Number: 118-080B <br />PAGE OF, <br />MBEIWBE Participation Goal <br />Project Name: Gemini Washington -Colfax Apartments — MASONRY & STAIR REPAIR <br />Bidder: PWI - Kyle Miller <br />By: Project Manager 1 Sales 10/5118 <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 MBENVBE FIRM: <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 MBEIWBE FIRM: <br />Version 7/20/2018 Contractor's Bid for Public Works - 11 <br />