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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 /> <br />Version 9/29/2021 Page - 11 Public Works Quote <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 /> <br /> <br /> Project Number: 120-010R Project Name: Walker Field House Restoration Project <br /> Bidder: Page ____ of _____ <br />DIVISION A MBE GOAL: 1.4% <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 of Total <br />Base Bid <br /> <br /> <br /> DIVISION A MBE TOTALS <br />ALTERNATE #1 MBE GOAL: 1.4% <br /> <br /> <br /> ALTERNATE #1 MBE TOTALS <br />Submitted by: <br /> Print Name Signature Date