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CITY OF SOUTH BEND <br />a 4f'� ilp <br />0- <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY) <br />eft <br />DEVELOPMENT PROGRAMFORM <br />�i <br />MWBE-1.0 <br />MBEIWB PARTIICIPATION <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE/MBE participation. <br />It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's <br />owned business. <br />Project Number: 118-307 _ _ Project Name: 2018 Demolitions <br />.. Bidder. R1t8CYlardmm-mBros., Inc. Total Bid Amount $318803. 00 MBE/WBE Goal: 7.1% <br />,mmm„m mm. �, _wwm m_mm_ <br />Page 1 of 1 <br />Name &Address of MBEhNBE ....Pri Primary <br />Contact Person (Attach scope/schedule Scope <br />of too bnee rf Amount <br />Wm Perc o o9al����� <br />ry p Performed Dollar Amount of <br />Ma i y additional space) MBEtWBE Component of To <br />... �. ... ...... .... ... ._. �_....... ., aL <br />Ritschard Bros., Inc. Rachelle L. <br />1Demolition $286, 773.0 89% <br />204 W. Sample St. Dolniak <br />South Bend., IN 46619 574-288-4777 <br />Submitted by: Rachelle L. Dolniakww ........—. <br />Print Name <br />Version 7/20/2018 Contractor's Bid for Public Works - 10 <br />November 13,�2018 <br />Date <br />