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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 -owned business meets the MBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: <br />Bidder: <br />123-076A Project Name: Beacon Health Parking Lot, 530 N. Lafavette Blvd. South Bend, IN <br />Gibson -Lewis, LLC Total Bid Amount: <br />MBE Goal: 2.6% <br />Page of <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 />Submitted by: Nick Gurbick, Vice President 12/10/24 <br />Print Name ignat re Date <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 />Version 07/19/2023 Contractor's Bid for Public Works -10 <br />