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CITY OF SOUTH BEND r ` <br />i s <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ;` � rF.�F <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 />***Goals should be calculated based on the Base Bid only.*** <br />C. Lee Construction Services, Inc. <br />Project Number: 123-014 <br />Project Name: <br />Bidder: C. L" Cov A"4^ kr Wk1d5. <br />a-, <br />Name & Address of MBE Primary Contact Person <br />(NamelTelephone) <br />SGrv-10, xr r- . 3 o o + <br />Demolition of 1000 West Sample Street <br />Base Bid Amount: l 0 zo. 0 D MBE Goal: 1.39% <br />Scope of Work to be Performed <br />(Attach scope/schedule if you need additional space) <br />Submitted by: 'rruLw LIB V0, <br />Print Name Signature <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 07/19/2023 Contractor's Bid for Public Works - 8 <br />Page If of I <br />Dollar Amount of MBE rVI�Vlna! <br />Component of Total <br />*a514titzS.00 1 6-1/, <br />°,r <br />Date <br />