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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />MBE UTILIZATION PLAN <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: 121-020 Project Name: <br />Bidder 1 VId S ►� cS� ILv�ila�'J <br />Bid Amount: MBE Goal: 4.3% <br />Page of <br />Name & Address of MBE <br />Primary Contact Person <br />(Namef telephone) <br />Scope of Work to be Performed <br />(Attach scope/schedule hedule if you need additional space) <br />Dollar Amount of MBE <br />Component <br />Percentage or 1'ct <br />Bid/Pr oral <br />5 5 ��� sk <br />��b� <br />C �,a<-1 �►� - SPS �a�� <br />) 00 �o <br />j 40 <br />ti4 � J�Itoa. <br />Submitted by: � <br />Print Name Signature I Date <br />Version 1113/2021 Page - 17 Public Works Quote <br />