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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ►` R/ <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 <br />involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE <br />qualifications. <br />***Goals should be calculated based on the Base Bid only.'` <br />Project Number: �1123-063R1 Project Name: Cleveland Road at Portage Road Traffic Signal Improvements <br />Bidder: .! N 7I �Wq S ph� L1 ) !1� Total Bid Amount: � A �j-7 US(). 00 MBE Goal: 1.57% <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 />h� I qq <br />�5 J <br />Lei+ bov I tZ <br />5'74-355--,U 5 <br />Submitted b : <br />s y T-0imer <br />Print Name Signature Date <br />Version 5/20/2024 Contractor's Bid for Public Works - 9 <br />