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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 woman -owned business meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />120-046 Project Name: Traffic Signal Detection Improvements <br />TGB Unlimited, Inc. (dba) S!T Bancroft Electric Total Bid Amount: <br />Name & Address of WBE Primary Contact Person Scope of Work to be Performed <br />(Namerrelephone) (Attach soope/schedule if you need additional space) <br />1 <br />State Barricading James Michalski Maintenance of Traffic <br />24963 US 20 574-287-1744 <br />South Bend, IN 46628 <br />Submitted by: <br />Gene Mann <br />Print Name <br />_4_zz-e tL�L� <br />Signa e <br />Version 08/25/2021 Contractor's Bid for Public Works - 14 <br />WBE Goal: 4.5% <br />Page 1 of 1 <br />Dollar Amount of WBE Percentage <br />of Total <br />Component o,,,,o_,,_ , <br />$10,902.00 <br />10-26-2021 <br />Date <br />4.5% <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 <br />WBE 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 woman -owned business meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />120-046 Project Name: Traffic Signal Detection Improvements <br />TGB Unlimited, Inc. (dba) S!T Bancroft Electric Total Bid Amount: <br />Name & Address of WBE Primary Contact Person Scope of Work to be Performed <br />(Namerrelephone) (Attach soope/schedule if you need additional space) <br />1 <br />State Barricading James Michalski Maintenance of Traffic <br />24963 US 20 574-287-1744 <br />South Bend, IN 46628 <br />Submitted by: <br />Gene Mann <br />Print Name <br />_4_zz-e tL�L� <br />Signa e <br />Version 08/25/2021 Contractor's Bid for Public Works - 14 <br />WBE Goal: 4.5% <br />Page 1 of 1 <br />Dollar Amount of WBE Percentage <br />of Total <br />Component o,,,,o_,,_ , <br />$10,902.00 <br />10-26-2021 <br />Date <br />4.5% <br />