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�11C_[1J i1j: , <br />CITY OF SOUTH BEND <br />fel •'� `�:� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 <br />IHI. <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 />121-036 <br />Project Name: <br />2021 Demolitions <br />:T" ; c� �4 a � � � Z'.-, Total Bid Amount: <br />WBE Goal: 4.7% <br />Page ( ofd_ <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 />kct 41./1 <br />:A(co - 3 41 - a <br />Submitted by: 01 <br />Print Name Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 10 <br />