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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: 124-064 LLProject Name: Demolition of 215 John on Street <br />Bidder: -17;, d ilna Total Bid Amount: 71, 170 MBE Goal: 2.54% <br />Page_ _of <br />Name & Address of MBE <br />Primary Contact Person <br />Name/Tele hone <br />( P ) <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 />i(en��c� <br />r1iJ al oc v f <br />17/ <br />Submitted by: ie <br />/ <br />PrA Name SigrJ ture Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 3/15/2024 Page - 26 Public Works Quote <br />