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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 <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: 121-016 Project Name: 2021 Contractor Paving Round 1 <br />Bidder: RiA i 1 51y� /7G . %n6- Total Bid Amount: 1'77eR, T �a3 ,,1 MBE Goal: 4.2% <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/Pro osal67 <br />'T <br />v`( <br />'` <br />70( �Roo, cc) <br />Submitted b Auc—K—aJ-4c) <br />y• <br />Print Name Sign ure Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 10 <br />