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CITY OF SOUTH BENDi� <br />J.D <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />MWBE UTILIZATION PLAN <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MWBE participation. It <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MWBE qualifications. <br />Project Number: 120-052 Project Name: <br />Bidder: J <br />Road and Sample Street Traffic I <br />Total Bid Amount: <br />MWBE Goal: 7.2% <br />Page of <br />Name 8 Address of MWBE <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 MWBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />51us <br />�l <br />o <br />AsU5 <br />,'5 <br />Il5 m Sfi <br />� <br />S7N-T�.-3101 <br />Po <br />E 3210 <br />M44C�i�ficg0l�A tnc. <br />10"5 <br />MQiA}cl P3 Tr ff'c. I+ewl, i <br />-71gW. <br />�- <br />A446; 46; US, AP Ut61 <br />M14aId, <br />P1- x27- jw7s <br />TANNER LEIBOVffZ /11�00, <br />3 -Zj.Z.� 1 <br />Submitted by: <br />Print Name Signature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 10 <br />