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-_0.ff RF <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 <br />xc <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 />122-028 <br />Project Name <br />2022 Street & Sewer Material Bid <br />Total Bid Amount: <br />WBE Goal NIA <br />Page of <br />Name & Address of WBE <br />Primary Contact Person <br />(NamelTelephone) <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 />Submitted by: <br />Print Name Signature <br />Version 09/2912021 Contractor's Bid for Public Works - 14 <br />Date <br />