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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 />is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 123-076A Project Name: Beacon Health Parking Loth,"530 NN1.�Lyafayette Blvd. South Bend, IN <br />Bidder: %n�iQA� A Q Total Bid Amount: �, _ (l /,r / r WBE Goal: 5.1 % <br />Page_t_of_L_ <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 />JJ <br />�/ <br />Submitted by: j4,1 /) U S/t(� <br />Print Name Signature Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 07/19/2023 Contractor's Bid for Public Works - 11 <br />J54,a <br />