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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 />123-042 <br />Project Name: Century Center North Restroom Renovation <br />Gibson -Lewis, LLC Total Bid Amount: <br />MBE Goal: 0.5% <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 osaI <br />Submitted by: Robert A. Lingenfelter, President <br />Print Name <br />Sig ature <br />6/13/23 <br />Date <br />Version 03/15/2023 Page - 20 Public Works Quote <br />