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Z <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-1.0 <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 or woman business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />122-0606 Project Name: Century Center Parking Lot Seal and Stripe <br />Total Bid Amount: <br />MBE Goal: 4.3% <br />Page of <br />Name & Address of MBE <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 MBE <br />Component <br />Percentage <br />Bid/Proporal <br />Submitted by: <br />Print Name <br />Signature <br />Date <br />CZ <br />V <br />t <br />C <br />CU <br />C3 <br />Version 06/012022 <br />Page - 22 <br />Public Works Quote <br />