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OSpt1iH pE,,�d, <br />CITY OF SOUTH BEND x' <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 A s <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: <br />Bidder: <br />123-012 <br />Project Name: <br />High <br />Street Sidewalk Project <br />Premium Concrete <br />Services Inc. <br />Total <br />Bid Amount: $ 244,139.00 WBE Goal: -5-+&* 5.13% <br />Page 1 off_ <br />Name &Address of WBE <br />Primary Contact Person <br />(Namelrelephone) <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 />SLUSSERS <br />JOHN WILLIAMSON <br />SODDING <br />$ 10,133.60 <br />0 <br />4.15 /o <br />State Barricading, Inc <br />James Michalski <br />Maintenance of Traffic <br />$ 502.00 <br />2.38% <br />Submitted by: Austin Redding A"' <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 - 9 <br />5/14/24 <br />Date <br />