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O G , <br />CITY OF SOUTH BEND`, <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANS <br />FORM WBE-1,01865 <br />M <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 <br />is 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 />Demolition of the South Bend Medical Foundation, 531 N. Main Street, South <br />123-076 Project Name: Bend, IN <br />Total Bid Amount: <br />WBE Goal: 4.7% <br />Page of <br />Name &Address of WBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(Attach scopelscheduie if you need additional space) <br />Dollar Amount of WBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />TBD <br />> $146,000.00 <br />> 4.7 <br />Submitted by: <br />Richard A Adamo <br />Print Name <br />q,t_ <br />Mzz <br />Sign re <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 07/19/2023 Contractor's Bid for Public Works - 11 <br />05/28/2024 <br />Date <br />