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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 or woman business meets the MBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 124-038R Project Name: WWTP Server Room Fire Suppression System <br />Bidder: <br />N/A <br />Total Bid Amount: N/A <br />MBE Goal: 0% <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 />N/A <br />Submitted by: <br />Print Name Signature <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 03/15/2024 Page - 28 Public Works Quote <br />Date <br />