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CITY OF SOUTH BEND <br />a <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN "EArf <br />4 <br />FORM MWBE-1.0 x <br />MWBE 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: <br />Bidder: <br />120-052R Project Name: Mayflower Road and Sample Street Traffic Improvements <br />Rieth-Riley Construction fl"Total Bid Amount: 357, 6 3.50 WBE Goal: 4.9% <br />Page 1 of 1 <br />Name & Address of MWBE <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 MWBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />Hawk Enterprise <br />Caylee <br />$145,862.30 <br />1850 E North St. <br />Carlson <br />Electrical <br />40.7% <br />Crown Point, IN 46307 <br />219-662-8090 <br />Submitted by: <br />Print Name <br />June 22, 2021 <br />Signature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 11 <br />