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CITY OF SOUTH BEND( <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />�x <br />IN6 i <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: <br />Bidder: <br />120-063 Project Name: 905-907-909 Michigan Demolition <br />7.n, 14"aAU Tn<- Total Bid Amount: Aoc, (,-a MBE Goal: 1.4% <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/Proposal <br /><a <br />J (W"� 1J Gzrr , c,w C <br />l <br />JcLr++.ef <br />57y-6LY7-,,b7y <br />� � <br />(l 43 <br />��1,1' I L � (l <br />v <br />Submitted by: ct �� �" �% '-r�✓z ; : d5, r'�/' `t — l 3 �'� <br />'Print Name Si nature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 8 <br />