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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 <br />WBE UTILIZATION PLAN <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 />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 123-014R Project Name: Demolition of 1000 West Sample Street <br />Bidder: �j) �qn �R�//j -�V� Base Bid Amount: 2 Ott WBE Goal: 4.65% <br />Page of_� <br />Name & Address of WBE <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 WBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />JJ 7 <br />V <br />V �`a <br />�'v in <br />3�. o�� <br />! <br />r7/ <br />0 <br />Submitted by:yc <br />e <br />Print Nam�r Signature Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 07/19/2023 Contractor's Bid for Public Works - 9 <br />