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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 <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 minority or woman business meets the WBE 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 />�`( Total Bid <br />Bidder: �nQ nCf✓irj� it r%i0/IS {�d4JwT �rr Amount: 9 13WBE Goal: S°lo <br />v <br />Page -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/Proposa <br />I <br />V10,rI —Te.k. <br />I wn L�nclscx.�. <br />I vldust"-d l SL)pp Ices , £Ylgi neerinc� F <br />£q✓o�ma.n�F <br />Ov,9`6 <br />Ql,(o3% <br />Submitted by: <br />Print Name Signature/Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 3/15/2024 Page - 23 Public Works Quote <br />