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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 _ - <br />MWBE UTILIZATION PLAN pass" <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: 120-059 Project Name: 2020 Community Crossings Round 2_ <br />Bidder: Milestone Contractors North Inc. Total Bid Amount: $287,200.00 WBE Goal: 5.9% <br />Page of <br />Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage <br />Name & Address of WBE Name/Tele hone of Total <br />( p ) (Attach scope/schedule if you need additional space) I Component OWID— —1 <br />V & R Trucking, Inc. Veda Godette Hauling - Materials 8 1845 N. Elmer Street 574-234-1268 $13,800.00 4.°/o <br />South Bend, IN 46628 <br />State Barricading, Inc. James Michalski Traffic Control Devices $3,378.00 1.1% <br />24963 US 20 574-287-2078 <br />South Bend, IN 46628 <br />Submitted by: Dustin_Hila� <br />Print Name ature Date <br />Version 01/13/2021 Contractor's Bid for Public Works -11 <br />