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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 Bid only.*** <br />Project Number: 124-058 Project Name: Locust Water Booster Pump Station Improvements <br />Bidder: minor✓P/% �t 7r dtC /��%[Jef7 �pC Total Bid Amount: /3 Y, Z 23. 00 MBE Goal: Z% <br />Page of <br />Name &Address of MBE <br />Primary Contact Person <br />Name/Tele hone ( p ) <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 Totalgid/Pro osal <br />eam Gv�s-�.✓ bup�l <br />U� <br />Cftx�slm�h�e� <br />barn <br />t7-yL3-23-75� <br />Ir1CIUS4ria-1 Supplies eEquiFjm,� <br />� 7,�t 3O.o� <br />5.7yv1) <br />r <br />Submitted by: l / / Z <br />A� <br />Print Name Signature Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 3/15/2024 Page - 22 Public Works Quote <br />