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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 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: 120-044R Project Name: Ignition Park: EV Charging Park <br />,�/ �1 <br />Bidder: �� C,� 6�4t-X,40111 <br />Total Bid Amount: � 3 2-21 q ® 3 WBE Goal: 4.2% <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 />(e*r— (0y f t�-,A <br />.� <br />3o 0 3 4��s <br />, 1 9 7 <br />Siv,f✓v, <br />1 V ��S <br />11 _ $5-/ e 7 3o I <br />Lc+Jse-G`p)n- � <br />5 <br />, I$ <br />S-7 7 <br />Submitted by: <br />Print Name Signature <br />Version 01/13/2021 Contractor's Bid for Public Works - 11 <br />/ /1-? 12, / <br />Date <br />