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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 <br />supplied with Bids that pertain <br />to City of South Bend <br />Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility <br />to verify whether any listed woman <br />-owned business <br />meets the WBE qualifications. <br />Project Number: 123-030 Project Name: `The Hill' TIF Project —Site Work <br />Bidder: &1l�G€TE- 5zWy4��iotal Bid Amount: 2c�, <br />6 0/0 = WBE Goal: 4.9 <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 />s�kJ <br />Submitted by: r 4x YZ4,kE <br />Print Name Signature <br />Version 09/29l2021 Contractor's Bid for Public Works - 9 <br />Date <br />