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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />4 <br />MBE/WBE PARTICIPATION <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 or woman business meets the qualifications of a Minority or Women's <br />owned business. <br />Project Number: 119-004Project Name: 2019 Curb and Sidewalk Construction __,_..._,_ <br />Bidder: Rieth-Rile o Total Bid Amount: 472,052.68 MBENVBE Goal: n/a <br />)L!;L_qst. Co., Inc. <br />Page 1 of <br />. ..... . - - <br />Name & Address of MBENVBE Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage <br />(Namerrelophone) (Attach scope/schedule If you need additional space) MBENVBE Component Of Total <br />.... . . ...... . . . . . ......... .. .. .. .. . Jjjd/Prn <br />n/a <br />- - - - - ---------- - <br />. ......... . . . . . ..................... <br />Submitted by: JoShua A. McCormick May 14, 2019 <br />------- -------- <br />Print Name <br />Date <br />Version 10/17/2017 Contractors Bid for Public Works - 4 <br />