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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 or woman business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />120-053 <br />Project Name: <br />Beck's Lake / LaSalle Park NPL Site <br />_L, A" C", EC." A, 77��c Total Bid Amount: 5 it 31�,Y F-0 MBE Goal: 1.0% <br />Page of <br />Name & Address of MBE <br />/coinir �F , <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />Iwi y <br />Percentage <br />of Total <br />Bid/Proposal <br />01 <br />rLt5 <br />FORM MWBE-1.0 <br />MWBE 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 or woman business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />120-053 <br />Project Name: <br />Beck's Lake / LaSalle Park NPL Site <br />_L, A" C", EC." A, 77��c Total Bid Amount: 5 it 31�,Y F-0 MBE Goal: 1.0% <br />Page of <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 />01 <br />rLt5 <br />Submitted by: ��1��,� i��� f����'Lv <br />Print Name -Signature <br />Version 01/13/2021 Contractor's Bid for Public Works - 9 <br />,5---5-- <br />Date <br />S—_S-- <br />Date <br />