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G <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE -1.0 res <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: 121-064A Project Name: Nexus Center Roof Replacement <br />Bidder: A4idland Engineering Company, Inc. Total Bid Amount: 232,600.00 MBE Goal: 0.6% <br />Page <br />Name &Address of MBE <br />Primary Contact Person <br />Name/Tele hone <br />( p ) <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 TotalBid/Proposal <br />)IA4 Roofing Company <br />1115 E. 9th Street <br />Indianapolis, IN 46202 <br />Jim Huntington <br />Material Supplier <br />1,395.60 <br />0.6% <br />Submitted by:ivlichael V/. Prahn, CPA President/CEO 12/13/22 <br />Print Name Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 10 <br />