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a 'fir <br />JZ <br />CITY OF SOUTH BEND,. <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE4.0 <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. 120-044R _ Project Name: Ignition Park: Ell Charring Park <br />Bidder: The Robert HenryCorporation Total Bid Amount: $ 413,317.00 MBE Goal: 2.4% <br />Page 1 of 1 <br />Name & Address of MBE <br />Primary Contact Person <br />hone <br />(Namelrel p ) <br />Scope of Work to be Performed <br />(Attach scope/schedule H you need additional space) <br />Dollar Amount of MBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />No MBE organizations have <br />responded at this time. <br />Submitted by: Brian S. Henry, President April 13, 2021 <br />Print Name Signature Date <br />Version 01/1312021 Contractor's Bid for Public Works -10 <br />