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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />= ' <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: 120-063 Project Name: 905-907-909 Michigan Demolition <br />Bidder: �e, i a o#al Bid Amount: MBE Goal: 1.4% <br />Page ( of <br />Name & Address of MBE <br />bz, /eO/es ,Lo C'a9- <br />Submitted by: /(�� <br />Print Name <br />Primary Contact Person <br />(NamelTelephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Version 01/13/2021 Contractors Bid for Public Works - 8 <br />Dollar Amount of MBE <br />Percentage <br />Component <br />of Total <br />BkUProposa <br />❑Ae <br />