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CITY OF SOUTH BEND �auw+ap <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITYJ' <br />DEVELOPMENT PROGRAM <br />FORM MWBE-1.0 <br />MBENVBE 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: 119-079 Project Name: 2019 Demolitions, Phase 2 <br />Bidder: Ritschard Bros. InC . <br />Total Bid Amount: 258 , 544 , 00 <br />..., MBENVBE Goal: <br />17 <br />Page 1 of 1 <br />Name& A M ...._ <br />Address of fVIQENUQE <br />Primary Contact Person ���� <br />,. ,��... __�___,..............�,,...� <br />of Work to be Performed � <br />Scopear <br />Dollar � <br />Amount of <br />Percentage <br />of Total <br />(NametTelephone} <br />............. <br />(A. <br />(Attach scope/schedule you space) <br />...._.,.... if ou need additional s....aca <br />P Went <br />�t1QElWEfE. Corn o� .. <br />Bid/Profaosal <br />�.�.�..� _.. <br />Ritschard Bros., Inc <br />Rachelle L. <br />1204 W. Sample St. <br />Dolniak <br />Demolition <br />$207,177.00 <br />80% <br />South Bend, IN 46619 <br />574-288-4777 <br />2 <br />Submitted by: _Rachelle L. Dolniak, <br />Print Name <br />Version 4/2/2019 Contractor's Bid for Public Works - 10 <br />Date <br />