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4Sp)TH SEA <br />O d ; <br />CITY OF SOUTH BEND �� x <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN�"°� <br />FORM WBE-1.0 x 1865 <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 />123-076 <br />Demolition of the South Bend Medical Foundation, 531 N. Main Street, South <br />Project Name: Bend, IN <br />Total Bid Amount: <br />WBE Goal: 4.7% <br />Page <br />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 />See good faith section <br />Submitted by: <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 - 11 <br />Date <br />