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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 buslnoss meats the MBE qualifications. <br />"*Goals should be calculated based on the Base Bid only.""' <br />Project Number: <br />Bidder: <br />123-068 Project Name: 2023 Residential Demolitions <br />GrBen Demolition Contractors, Inc. Base Bid Amount: $$372,450.00 <br />Name & Address of MBE <br />MBE Goal: 1.4% <br />Page 1 of 2 <br />Primary Contact Ps— Scope of Work to be Performed Cdlw Amount of MBE Pere <br />(NameRelephone) (Attach scopetschedule If you need additional space) Component Of <br />Bld/F <br />San Corporation Sandra Smith Trucking & Hauling Debris to and from site $150,000.00 33% <br />1112 East Summit St 219-299-6830 <br />Crown Point, Indiana 46307 <br />Submitted by: Michael BrcughZ_ 11-27-22! <br />Print Name Signature Date <br />* Goals should be calcul d based on the Base Bid only. — <br />Version 07/19/2023 Contractors Bid for Public Works - 9 <br />