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CITY OF SOUTH BEND ° <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN z' <br />FORM WBE-1.0 <br />WBE UTILIZATION PLAN <br />This completed form should be <br />supplied with Bids that pertain to City of South Bend <br />Public Works Projects involving WBE <br />participation. It is <br />the bidder's sole responsibility <br />to verify whether any listed woman -owned business <br />meets the WBE qualifications. <br />Project Number: <br />Bidder: <br />123-044 Project Name: <br />Premium Concrete Services Inc. <br />Total Bid Amount: 71001 7 f7 WBE Goal: 3.83% <br />Page of 1 <br />Name &Address of WBE <br />Primary Contact Person <br />(Namefrelephone) <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 />Submitted by: Austin Redding, <br />Print Name Signature <br />Version 09/29/2021 Contractor's Bid for Public Works - 12 <br />9/12/23 <br />Date <br />