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CITY OF SOUTH BEND S'ov°"' 114i <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY ,„ �. <br />DEVELOPMENT PROGRAM 15 <br />FORM MWBE-1.0 <br />MBEIWBE PARTICIPATION�s <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: 117-108 <br />Bidder: Selge Construction <br />........ ....... <br />........Pnma <br />Project Name: <br />Co, <br />Airport Annexation Area Sanitary � ewer Extension <br />I <br />_Etal Bid Amount: $1 ,, 087� 164.20 <br />_.� <br />MBE/wBE Goal. <br />Page 1 <br />............1 %�... <br />Of 1 <br />& Atldress of MBEMIBE <br />Contact Person <br />Namelrele hone <br />( p ) <br />�....�....__ ..��.... Sw a of Work to be PerformrY p ed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of <br />MBE/WBE Component- <br />Percentage <br />...................... <br />e Barricading <br />F24963 <br />__---._ <br />_._ww ._.......�-._........ <br />-. .... <br />Bid/PrO osal . <br />US 20 West <br />James <br />Traffic Control <br />$4,750.00 <br />Od <br />ISO. Bend, IN 46628 <br />Slusser's Green Thtmb <br />PO Box 33 <br />John <br />Restoration <br />$20,400.00 <br />(10 <br />Logansport, IN 46947 <br />_W......... <br />�... <br />_......._... <br />_. <br />Submitted by: F wl <br />1 te:.w <br />_.�.._---------.._. ...................... <br />11 /27/28 <br />Pant Name <br />Engineer <br />Signature <br />Date <br />_...--... <br />Version 7/20/2018 Contractors Bid for Public Works- 9 <br />