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of Total <br />___ ____ <br />Percentage <br />of <br />Bid/Proposal <br />3.55% <br />_______ <br />Page <br />MWBE Goal: <br />Component <br />Date <br />Dollar Amount of MWBE <br />Public Works Quote <br />INCLUSION PROGRAM PLAN <br />.0 <br />1 <br />- <br />17 <br />- <br />Scope of Work to be Performed Page <br />scope/schedule if you need additional space) <br />Century Center North Restroom RenovationTotal Bid Amount: <br />(Attach <br />FORM MWBE <br />ITY OF SOUTH BEND <br />Signature <br />C <br />MWBE UTILIZATION PLAN <br />Project Name: <br />(Name/Telephone) <br />Primary Contact Person <br />104CR <br />- <br />118 <br />MINORITY AND WOMEN BUSINESS ENTERPRISE <br />should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MWBE participation. It <br />ersion 4/2/2019 <br />V <br />Print Name <br />: <br />Name & Address of MWBE <br />Project NumberBidder:Submitted by: <br />This completed form <br /> <br />