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4SOUTH gE� <br />CITY OF SOUTH BEND d <br />e <br />� <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN �� reeca� <br />FORM WBE-1.0 1865 x <br />WBE UTILIZATION PLAN <br />***Goals should be calculated based on the Base Bid only.*** <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: 124-052 <br />Bidder: <br />Division 1 — WBE Goal: 4.46% <br />Project Name: 2024 Electric Vehicle Supply Equipment (EVSE) Installation <br />Total Bid Amount: <br />Division 1 Bid Amount: <br />3 pages <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/Proposal <br />Version 3/15/2024 Page - 29 Public Works Quote <br />