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CITY OF SOUTH BEND abrae <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY %, <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBE/WBE PARTICIPATION " <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: 118-043R _....... Project Name: VPA Restroom Remodeling <br />Bidder: Michiana COntrdCtln ,Inc _ Total Bid Amount: 490,000.00 MBENVBE Goal: 0% <br />Page__I`of--I_ <br />Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage <br />Name Address of MBrANBE (Namefrelephone) (Attach scope/schedule if you need additional space) MBEIWBE Component of Total <br />BIdIPro osai <br />DA Dodd, LLC 574-968-0589 Plumbing $120,920.00 24.6% <br />2516 N. Home Street Douglas Bourne <br />Mishawaka, IN 46545 <br />Submitted by: Scott Kirkpatrick, _resident � December 20, 2018 <br />. P _ _. _. . <br />Print Name Signature Date <br />