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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE:-1.0 <br />WBE UTILIZATION PLAN <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. <br />Project Number <br />Bidder: <br />120-010R Project Name: Walker Field House Restoration Project <br />DIVISION A WBE GOAL: 4.7% <br />Page of <br />Name & Address of WBE <br />Primary Contact <br />Person <br />(Name/Telephone) <br />Scope: of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Dollar Amount of <br />WBE Component <br />Percentage of Total <br />Base Bid <br />i Ae; -` Reols 1 <br />71,"" q2 3 - 5 <br />� t 1' -� 4, i'e � � <br />Al <br />�, <br />DIVISION A WBE TOTALS <br />ALTERNATE #1 WBE GOAL: 4.7% <br />Submitted by: ,/ f;�, v1 �' �' �,v ".�-� V =' <br />Print Name Signature= Date <br />Version 9/29/2021 Page - 12 Public Works Quote <br />