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Bidder/Respondentwill submit <br /> <br />this completed document with <br />Bid/Proposal. <br />&ȁΑȀ 34!4%-%.4 /& ).4%.4 /& -/"ȝ7/"ȝ3%#4)/. Β 54),):!4)/. <br />I,_certifythat_________ _______________________()will / ( )will not <br />will utilize Minority Owned Business (MOB) or Women Owned Business (WOB) as subcontractor(s), vendor(s), <br />supplier(s), or professional service(s). The estimated dollar value of the amount that we plan to pay the MOB or <br />WOB subcontractor(s), vendor(s), supplier(s), or professional service(s)is$_______. <br /> <br />Race/ Section 3 Name of MOB/WOB/Section 3 <br />Description of WorkMOBWOB Amount <br />Amount $Ethnicity$ Amount $Organization/Address <br /> <br />This certification is a material representation of fact upon which reliance was placed when this transaction was <br />made or entered into. The City reserves the right to withdraw or terminate the proposed contract should the <br />representation of fact be false. <br /> <br />Signature and Date: _____________________________________________________________ <br />Printed Name: _________________________________________________________________ <br />Position: ______________________________________________________________________ <br /> <br />Page 2 of 2 <br /> <br />Page 33 of 44 <br /> <br />