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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 pertah <br />participation. It is the bidder's sole responsibility to verify whether any listed <br />Project Number: 121-072 Project Name: <br />Bidder:a-R;InH <br />Bend Public Works Projects involving MBE <br />business meets the MBE qualifications. <br />Mishawaka Avenue Streetscape <br />Total Bid Amount: # 3. �/ , --273. �2 7 MBE Goal: 2.33% <br />Page 9 of J <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 />Ukizs l�;S�`cs, LLC. <br />,2,� 13 S4' Chei-rfts Ave- <br />Sow 5,&h I IN 4/&y <br />�i nark Cov%ce <br />5741, 113•do71 <br />"T�vc{ i n� 1 t{cc✓�in� <br />4 �D, 1b0. L�6 <br />�. 3`{04 <br />Submitted by: ya ooa b ga✓Am AaAMAL� P. t e ' a� <br />Print Name Signature Date <br />