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CITY OF SOUTH BEND y `� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE -1.0 <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 />121-036 <br />Project Name: 2021 Demolitions <br />,1,, S w C - 114 , ..7 ,. Total Bid Amount: <br />MBE Goal: 1.4% <br />PageJof� <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 />.-/-V •T' �1�� ����S.TC,f <br />lJ cr/lµ�'� <br />993-- <br />lf�v I <br />Ay <br />Submitted by: Ci r � 0,d_ <br />Print Name Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 9 <br />