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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY. <br />DEVELOPMENT PROGRAM. <br />FORM MWBE-1.0 <br />MBEN SE PARTICIPATION <br />This 4irmplatsd form should be suppllod with Blde that pertain to City of South Beryl Public Works Projects involving MBEIMBE partlolpatlom <br />It Is the bidtler's sole responslblllly to vodfy whether any listed minority or women business meets the quagRoellons of a Minority or Women's <br />owned business. <br />Project Number. 118-104D Project Name: <br />Bidder: Gibsolt.L..mis t.j f total Bid Amount: MBFJW13EGoal: <br />Pape of <br />Names ddreas of MBENME t eConleolPereon Scope or%wk to be Performed DoAsrAmoualof afToeaa <br />(AltachawpePoclmdulairyou need addiliorml space) MBPAMIE Cumponent dF Tnla1 <br />Pr NBRI IFolephonel.. �__s...„u„_..,v. ,............ �„�,� ......�.� _�..._...,._�..w.... ... ....�.,,�....�..,n� _.m., . �.�!?!�9il�_ <br />i <br />Submitted by: R0hL''1( 1, N 11�"evdwPsv.+idc nt """ 2/27/2020 <br />Print Name St.w. .�s_.�� �,. ..�..� .... ....�.. .�.. ..M. .._.�.......�.�.� <br />ignature Data <br />Version 4/?V1018 Contractors Bid for Pubile Wake -9 <br />