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�1(�� Fi3 lst��' <br />CITY OF SOUTH BEND (� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSIO �QR'1VI PLAN <br />FORM MBE -1.0.w <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 />2022 Community Crossings Roadway Rehabilitation Project - Divisions 1 B, 213, <br />122-024R Project Name: 3B, 4 and 5 <br />Rieth-Riley Construction Co., Inc. Total Bid Amount: N/A (NO BID) <br />MBE Goal: 3.1% <br />Page of <br />Name & Address of MBE <br />Primary Contact Person <br />(Name/Teleplione) <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 <br />Version 09/29/2021 Contractor's Bid for Public Works - 27 <br />Date <br />