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CITY OF SOUTH BEND ` <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN (P <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 -owned business meets the MBE qualifications. <br />Project Number: 125-005 Project Name: <br />Bidder: 1) <br />2025 Street & Sewer Material Bid <br />Total Bid Amount: <br />MBE Goal: N/A <br />Page Page 1. 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 ntof MBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />v <br />Submitted by: <br />Print Name Signature <br />Version 07/19/2023 Contractor's Bid for Public Works - 13 <br />Date <br />