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<br />SCHEDULE OF MBE PARTICIPATION <br /> <br />NAME OF Vendor --1J A <br />PROJECT TITLE <br />BID NUMBER <br /> <br />TOTAL BASE BI D AMOUNT <br /> <br />NAME OF <br />MBE <br /> <br />TYPE OF WORK TO <br />BE PERFOmfED <br /> <br />TYPE OF <br />MBE <br /> <br />BIDDER! <br />SUPPLIER <br /> <br />TOTAL <br />C~CT <br />VALUE <br /> <br />Subcontractor Total Va1ues <br />Hispanic, Asian-American Participation Total Value: $ <br />African-American Participation Total Value: $ <br />Native-American Participation Total Value: $ <br />Woman Participation Total Value: $ <br /> <br />Suppl.ier Total Va1ues <br />oHispanic, Asian-American Participation Total Value: <br />AZxican-American Participation Total Value: <br />Native-American Participation Total Value: <br />Woman Participation Total Value: <br /> <br />x <br />X <br />X <br />X <br /> <br />60% <br />60% <br />60% <br />60% <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />The undersigned will enter into a formal Agreement with the MBE <br />Suppliers/Consultants/Subcontractors/Bidders identified herein for work <br />listed in this schedule conditioned upon execution of a contract with <br />the City of Jacksonville. Under penalties of perjury I declare that I <br />have read the foregoing conditions and instructions and the facts are <br />true ~o the best of my ~'owledge and beliefs. <br /> <br />Signature: DW-1~ f{laiu~ Rrs, dtf)-r <br /> <br />Date: /vI(.J(t:{1 oi ; 2O{D <br /> <br />FORM 1 <br /> <br />2 <br /> <br />SIB <br />