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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />WBE UTILIZATION PLAN <br />Version 1/13/2021 Page - 18 Public Works Quote <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MWBE participation. It <br />is the bidder’s sole responsibility to verify whether any listed minority or woman business meets the MWBE qualifications. <br />Project Number: 121-035 Project Name: 2021 Microsurfacing <br />Bidder: Total Bid Amount: WBE Goal: 6.1% <br />Page_______of___ ____ <br />Name & Address of WBE 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 />Submitted by: <br />Print Name Signature Date