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%jU rll q, <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 <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MBE qualifications. <br />Project Number: 123-049 Project Name: SBFD Parking Lot Rehab <br />Bidder: 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 />of Total <br />Bid/Pro osal <br />Submitted by: <br />Print Name <br />Signature <br />Date <br />Version 03/152023 Page - 25 Public Works Quote <br />