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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 -owned business meets the MBE qualifications. <br />Project Number: <br />Bidder: <br />121-066 <br />Project Name: Pure Green Farms Site Improvements <br />Total Bid Amount: 3 <br />�� <br />MBE Goal: 2.7% <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/Proposal <br />'[+j'•�z.r�J��,�y- E//�r�'�fsl,•�, <br />f"'+u...�r.+sf Flo^��,.,� <br />-'(r��tcr'� � i-l�.�l�;�. <br />J <br />Sohn dL^3 IN tf(d�t� <br />� -f+t i� �" J►wi (.G.�� ^� <br />�t`-�h.t 3 M�` G�(� I f �fY <br />-fr ,• . /� f� 'C- �^� I <br />P r� � � <br />q 6 � <br />d a 14k /A 1_4I4/ <br />Submitted by: <br />Print Name Signature Date <br />Version 09/29/2021 Contractor's Bid for Public Works - 9 <br />