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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-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 -owned business meets the WBE qualifications. <br />Project Number: 122-028 Project Name: 2022 Street & Sewer Material Bid <br />Bidder:X. otal Bid Amount: �+SC,i,�a 0o WBE Goal: N/A <br />Page 4– ofA— <br />Name &Address of WBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(pAttach scope/schedule if you need additional space) <br />Dollar Amount of WBE <br />Component <br />Percentage <br />of TotalBid/Proposal <br />o <br />1 S d1. <br />D VO <br />Submitted by: ?=AAr <br />Print Name Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 14 <br />