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tipli <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0,;;.,v'^ <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 <br />Bidder: <br />120-063R <br />Project Name: <br />905-907-909 Michi <br />Total Bid Amount: <br />ition <br />WBE Goal: 4.7% <br />Page 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 />wt� �Gt.rr(c.y �� <br />01 ` <br />:Ju,wiz�. �i,��u�J/C, <br />6 -7Y_ qj -7, 1�0 7a <br />�r'G,;1�7%C. (�h✓t-fr�� <br />1)LP/p q <br />J. <br />-7 <br />% <br />Submitted by: , <br />6 7 - <br />'Print Name Signature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 9 <br />