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CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 MBE UTILIZATION PLAN Version 07/19/2023 Contractor’s Bid for Public Works - 10 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder’s sole responsibility to verify whether any listed minority-owned business meets the MBE qualifications. ***Goals should be calculated based on the Base Bid only.*** ***Goals should be calculated based on the Base Bid only.*** Project Number: 123-076 Project Name: Demolition of the South Bend Medical Foundation, 531 N. Main Street, South Bend, IN Bidder: Total Bid Amount: MBE Goal: 1.4% Page_______of___ ____ Name & Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal Submitted by: Print Name Signature Date CallCarbonCarl Jackson5/24/20241ST CLASS LOGISTICS2213 ST CHARLES AVESOUTH BEND,IN 46614BENARD COUTEE574-993-0071TRUCKING/HAULING$160,0005%Walsh Construction Company II, LLC$2,932,000