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ot�urx ef!. <br />CITY OF SOUTH BEND ° i <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN r <br />FORM MWBE-1.0.i <br />MWBE UTILIZATION PLAN <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. <br />Project Number: 120-062 Project Name: 3400 Block 5. Mi <br />Bidder: FAa^XuA fen)!2&?� SGkVS��S Total Bid Amount: <br />4 P,31 go 9 WBE Goal: 4.7% <br />Page of <br />Name & Address of WBE <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 WBE <br />Component <br />Percentage of Total <br />Bid/Pro osal <br />q�k E1JT£lLQlCSS�s-,4aa <br />O44ak- <br />fSE»iod7E <br />5=G R�F <br />Oa <br />y <br />s% <br />/ <br />ANOR?coJ <br />;i q, ��r <br />{ <br />1650 5*5T � 0, r/, <br />�t 15� �p�o�'809D <br />L£� � <br />LSGHT <br />rY <br />GVa+t OoZa7 2n1 y6307 <br />5578 n.4RO <br />TAAFFi[- &WrXDL <br />�J. PrtcrFSG <br />3AAXY 'r=,,,t,4 <br />14AXrJTEx0Aavc6 Of %4'fFFXC- <br />`�o <br />3,6< <br />l$Iv <br />-7-7;Z-7-7;Z_700 ( <br />/ <br />K,70X I T -J �{f9S3 y <br />Submitted by: Rata j35-6K&,e— 2z,;R-- <br />Print <br />Name Signature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 11 <br />