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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-2.0 <br />EVIDENCE OF GOOD FAITH EFFORTS <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. <br />Project Number: 122-049 Project Name: Cleveland Road and Ameritech Drive Intersection Improvements <br />Bidder: Milestone Contractors North, Inc. Total Bid Amount: $1,281,000.00 WBE Goal: 5.64% <br />Page 1 of 1 <br />Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage <br />Name & Address of WBE (Name/Telephone) (Attach scope/schedule if you need additional space) Component of Total <br />Bid/Proposal <br />State Barricading, Inc. James Michalski Maintainingof Traffic o <br />24963 US 20 W. 574-287-2078 $73,000.00 5.70 /o <br />South Bend, IN 46628 <br />I <br />Submitted by: Lynn J. Bauer, VP/Area Manager, South Bend Ca. � A q 1.a� <br />Print Name Signature Q U <br />Version 09/29/2021 Contractor's Bid for Public Works - 10 <br />8/22/2023 <br />Date <br />