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F'"ad,4t <br />Y" <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />� '"G� ;f <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 WBE participation. It <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />123-049 <br />Project Name: SBFD Parking Lot Rehab <br />Rieth-Riley Total Bid Amount: $96,821.00 WBE Goal: 6.1 % <br />Page 1 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 />Javelina Construction <br />13376 Britton Park Road <br />Fishers, IN 46038 <br />Tanner Fortune <br />317-841-8364 <br />tanner avelinarnilli <br />Asphalt Milling <br />$6,138.30 <br />6.34% <br />ng.com <br />VJLSubmitted by: <br />Print Name Si nature <br />Date <br />Version 03/15/2023 Page - 26 Public Works Quote <br />