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4SOUTH BEd <br />CITY OF SOUTH BEND c <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-1.0 x <br />aes <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 Bid only.*** <br />Project Number: 124-052 Project Name: 2024 Electric Vehicle Supply Equipment (EVSE) Installation <br />Bidder: Total Bid Amount: 3 pages <br />Division 1 — MBE Goal: 1.59% <br />Division 1 Bid Amount: <br />Name & Address of MBE <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 MBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />Version 3/15/2024 Page - 26 Public Works Quote <br />