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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 />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 124-038R Project Name <br />Bidder: N/A <br />WWTP Server Room Fire Suppression System <br />Total Bid <br />Amount: N/A WBE Goal: 0% <br />Page <br />of <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/Proposa <br />I <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 - 29 Public Works Quote <br />Date <br />