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1 <br />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: 123-076A Projj�e//ct Name: Beacon Health P <br />Bidder: (,�jGx/1G1 ,/4r)q, 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 />Ken��� <br />ve � <br />��A �� v� <br />7`-/—Y7Gr� <br />�) iV Gk 1/1 <br />�� S� r3`� <br />z.610 <br />Submitted by:'! d,51r'_Ar-,�1r�,�� <br />Print Name Signature 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 />