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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />Iti15 <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 <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. <br />Project Number: 120-009 Project Name: Dubail Avenue Streetscape <br />Bidder: 1-✓► �. yen 4 4EcL�, ?,� Total Bid Amount: MBE Goal: 3.1 <br />Page_of <br />Name & Address of MBE <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 MBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />Submitted by: M (1, P <br />Print Name gnature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 11 <br />