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p 1, <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN " <br />FORM MBE-1.0 <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 or woman business meets the MBE qualifications. <br />***Goals should be calculated based on the Base Quote only."* <br />Project Number: 124-049n� Project Name: 2024 Microsurfacino Quote <br />Bidder: NA7/aw4L p4Jtla4NT Total Bid Amount: MBE Goal: N/A <br />Page! of / <br />Noma 8 Merest of MBE <br />Primary contact Person <br />(Neme/Tebphone) <br />PB <br />Sco of Work to be Perfom�e0 <br />cb <br />(Aaeawche pe/s0ub rtyou neetl atltlNonal space) <br />Dollar Amount of MBE <br />Compon <br />Pe.ftlage <br />of Totalent <br />BItlIP oael <br />$7'a7£ 1 2R1CH6/rE*j <br />-Syw4s 6..1c..LSK/ <br />Qk A/.3 /34rcn.,rp.i- <br />I�fN7•<< 64 5 5 <br />?'f9�3 US �s wcsT <br />$741-2g7-Jc78 <br />561.1�k 13rsrd', zw �toas <br />'S'FwEL Lau xiRAc'�/n� <br />Qf2i [MASa'1� <br />�iwrt PENT �¢slaq¢ftfi✓v- <br />$c43 5ak'4.13�—J Av'( <br />y(L� <br />�5 i /.a+LArCtw Fi yuKE�trfNT <br />M4 <br />Tll V66,S7 <br />f 5E-f mot' <br />Submitted by: /Vfl, 4{ ,kw 7Jr5�Z7y <br />Pdnt Name Signature Date <br />***Goals should be calculated based on the Base Quote only.`** <br />Version 3/1512024 Page - 22 Public Works Quate <br />