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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANS y' <br />FORM MWBE-1.0 ry'' ..''' <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: 121-016 Project Name: 2021 Contractor Paving Round 1 <br />Bidder:1 ,+;;y� C�6 /e� Total Bid Amount: 7 3, -3 WBE Goal: 6.0% <br />Page I 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 <br />of Total <br />Bid/Proposal <br />.--ice <br />Jq7 5,,Kq 3o <br />W77,2/ <br />p <br />�3 <br />. <br />J j4�—e-soi, oa f e, A7 9`7130 <br />` k <br />�t3-"'� <br />ail �v T'� a-6 4L ?`ia%, G � <br />5-7 , 71, 7,00 � <br />E�1 <br />��+J ` N "-1 5 <br />Submitted by: /-u q-(-3--J0J1 <br />Print Name Signature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 11 <br />