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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 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: 121-019 Project Name: Brick Pavement Spot Repair 2021 <br />Bidder: Selge Construction Co.,, Inc. Total Bid Amount: <br />$360,781.00 MWBE Goal: 5.7% <br />Page 1 of 1 <br />Name & Address of MWBE <br />Primary Contact Person <br />Namefrele hone <br />( p ) <br />Scope of Work to be Performed <br />Attach scope/schedule <br />( pe/schedule ff you need additional space) <br />Dollar Amount of MWBE <br />Component <br />Percentage <br />of Total <br />Bid/Pr000sal <br />State Barricading, Inc. <br />24963 US 20 West <br />South Bend, IN 46628 <br />Mary Michalski <br />574-287-2078 <br />Traffic Control <br />$2,500.00 <br />0 7% <br />Submitted by: Robert Kuhns, Project Engineer <br />Print Name <br />-F-2P P . <br />Signature <br />July 13, 2021 <br />Date <br />Version 2/14/2020 Page - 27 Public Works Quote <br />