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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-1.0 <br />MBE UTILIZATION PLAN <br />Version 09/29/2021 Contractor’s Bid for Public Works - 8 <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:121-029C Project Name:Morris Box Office Renovation <br />Bidder: Total Bid Amount: MBE Goal: 3.1% <br />Page_______of___ ____ <br />Name & Address of MBE 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 />Submitted by: <br />Print Name Signature Date <br />Larson-Danielson Const. Co., Inc. <br />1 1 <br />Brian T. Larson, President X 7/26/22 <br />LARSON-DANIELSON <br />CONSTRUCTION CO., INC. <br />S T ATE OF <br />INDIA AN <br />SEAL <br />Corporate