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CITY OF SOUTH BEND <br />°+!A <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 -owned business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />123-021 <br />2023 Contractor Paving Round 1 <br />� -�,� .,, I : . Total Bid Amount: k j, 0 (o 0, 7) 00 - 0 0 MBE Goal: 4.22% <br />Project Name <br />Page 1 of 1 <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 />of Total <br />Bid/Proposal <br />&)uencl.4 8.J 4&614 <br />00 <br />Submitted by: 4,44 h n A,A` <br />rint Name Signature <br />Version 09/29/2021 Contractor's Bid for Public Works - 9 <br />Date <br />