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tipD'fN /fE\. <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE -1.0 x %x <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 />118-005B Project Name <br />711 J,1v.,,4 , A, 1,,, Total Bid Amount: <br />Riverside Drive Bank Stabilization <br />MBE Goal: 0.3% <br />Page j —of� <br />Name & Address of MBE <br />Primary Contact Person <br />(Name(felephone) <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 />/ <br />Submitted by. d fl[c, K Q .SIS ��•s, �1� d4 aj <br />Print Name Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 9 <br />