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<br />, . <br /> <br />.- <br /> <br />.-. <br /> <br />MINORITY AND WOMEN BUSINESS ENTERPRISES <br />PARTICIPATION REPORT FORM <br />MIWBE-1 <br /> <br />Project No. <br /> <br />Project Title: <br /> <br />Date: <br /> <br />College, Institution or Agency <br /> <br />Principal Representative <br /> <br />$ <br /> <br />MBE: Yes 0 WBE: Yes 0 <br />No 0 No 0 <br /> <br />Architect or Contractor <br /> <br />23.8% <br /> <br />Total Contract <br />Amount <br /> <br />17 % ~ <br />MBE% Goal <br /> <br />WBE % Goal <br /> <br />Name and Address of M/WBE MBE WBE Type of Work <br />Subcontractors and/or Suppliers and/or Contract Contract <br />Self-Perfonned Work by M/WBE Primes. Amounts Amounts <br /> <br />.Indicate ethnicity based on Paragraph III. A. above. <br />Total MBE Contracts: $ <br />Total WBE Contracts: $ <br />Total MBE %: <br />Total WBE %: <br /> <br />SIGNATURES: <br /> <br />Principal Representative <br /> <br />fu~ ~?/L <br /> <br />thorized Representati e <br /> <br />Architect or Contractor <br /> <br />Authorized Representative <br />