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�l lull ii,l. <br />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 vvor- par iicipauuil. IL I, <br />the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />122-060B <br />Project Name: Century Center Parking Lot Seal and Stripe <br />,14blbt�L 1�"VEliifat l A*114— Total Bid Amount: <br />WBE Goal: 6.1% <br />Page of <br />Name &Address of WBE <br />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 WBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />Submitted by: ( 1R vl {'11.iAAAk,(ptr4 ./� U-,--: a" <br />Print Name I Signature <br />Date <br />Version 06/01 /2022 Page - 23 Public Works Quote <br />