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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 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 />120-063R <br />Project Name: <br />905-907-909 Michigan Demolition <br />17, J.' a- n V &� ,r Total Bid Amount: <br />MBE Goal: 1.4% <br />Page of <br />Name & Address of MBE <br />Primary Contact Person <br />(NamelTelephone) <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/Pro osal <br />J� LIGJ.i CIiJ^�'1>�4j <br />X43 <br />Uc9 vl�'�t ,� �.� � .ir✓ <br />�ar�1w/� C-cufee <br />Submitted by: (Crk, 6,,S/w <br />Print Name 919nature <br />Version 01/13/2021 Contractor's Bid for Public Works - 8 <br />Date <br />