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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 WBE participation. It <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. <br />Project Number: 120-009 Project Name: Dubail Avenue Streetscape <br />Bidder: r 0_,�,l(4, c Total Bid Amount: ,3S'/ o,?7, 8� WBE Goal: 5.5% <br />Page__L_of t <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 />5Q, ptt r✓��'C yJG <br />i�ar,• dLj <br />c Dj �S 7, CL <br />,�'ty(,.3 Us J�U w-,i� <br />571- a,? 110 71 <br />iTcu.V �� e n Te r �l rJ.i til <br />��� �. �/L cSb.1 <br />,,• <br />� <br />O <br />1850 C- /-6.-•f (1 �. <br />dlq , 663, ev7z) <br />Submitted by: J a a r <br />Print Name Signature Date <br />Version 01/13/2021 Contractor's Bid for Public Works - 12 <br />