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This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is <br />the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />120-062 Project Name: 3400 Block S. Michigan street improvements <br />ja9,EwtE4nt CD1ICRfi7S- JT.GES Total Bid Amount: "373F905' <br />MBE Goal: 2.6% <br />Page of <br />Name & Address of MBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of MBE <br />Component <br />CITY OF SOUTH BENDMINORITY <br />AND AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />se <br />MWBE UTILIZATION PLAN <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is <br />the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />120-062 Project Name: 3400 Block S. Michigan street improvements <br />ja9,EwtE4nt CD1ICRfi7S- JT.GES Total Bid Amount: "373F905' <br />MBE Goal: 2.6% <br />Page of <br />Name & Address of MBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of MBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />Submitted by: <br />a� a &R ��I 1;�3/2 <br />Print Name Signa ure Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 10 <br />