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This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is <br />the bidder's sole responsibility to verify whether any listed minority-owned business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />120-026 Project Name: <br />=,,J. <br />IF¢..411 _ Z. <br />Airport Annexation Area Water Main Extension <br />Total Bid Amount: 3 % �{� '�yi , c?O _ MBE Goal _1,. �-1 <br />Page 1 aft_ <br />Name & Address of MBE <br />.}_ A <br />CITY OF SOUTH BEND <br />Dollar Amount of MBE <br />Component <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />S QUss <br />FORM MWBE-1.0 <br />, <br />MBE 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 is <br />the bidder's sole responsibility to verify whether any listed minority-owned business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />120-026 Project Name: <br />=,,J. <br />IF¢..411 _ Z. <br />Airport Annexation Area Water Main Extension <br />Total Bid Amount: 3 % �{� '�yi , c?O _ MBE Goal _1,. �-1 <br />Page 1 aft_ <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/Pro osal <br />S QUss <br />( <br />Submitted by: C,k v.S l er <br />Print Name Si nature Date <br />Version 08/25/2021 CONTRACTOR'S BID FOR PUBLIC WORK - 8 <br />