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CITY OF SOUTH BEND <br />, IAf <br />O -moi.} <br />�Y�4 <br />l <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />�' <br />FORM MWBE-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 business meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />120-02/I6 Project Name: Airport Annexation Area Water Main Extension_ <br />TE¢-44, ?,c- Total Bid Amount: 3 % %, cp <br />WBE Goal: 'f.-790 <br />Page l of r <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/Propos I <br />ci.+c7 <br />�7 <br />�IIsSS'¢rs �re� Tivro� <br />IT -An <br />SeC-J, <br />J <br />8, P 70 0,0 <br />v <br />1 "onioo/ %cr7 rL`1 , n, <br />ea IC -e\ <br />Ji/ <br />Submitted by: f� al, K 0,S le-,,- // - k- <br />Print Name Signature Date <br />Version 08/25/2021 CONTRACTOR'S BID FOR PUBLIC WORK - 9 <br />