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J <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-1.0 :=/r <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 />Project Number: <br />Bidder: <br />119-031C Project Name: Drewry's Brewery Cleanup, Phase I <br />T Base Bid Amount: � ,� `j4 -, MBE Goal: 1.30% <br />Page_L_ofJ <br />Name & Address of MBE <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 MBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />ft V5 <br />I <br />Kin <br />�" <br />�0 <br />I1,36 <br />Submitted b : X,ld �1 �y�5t Ki y <br />Print Name Signature Date <br />*'Goals should be calculated based on the Base Bid only.*** <br />Version 07/19/2023 Contractor's Bid for Public Works - 8 <br />