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f4 �GTFI �iJ <br />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: 125-017 Project Name: Urban Tree Nursery Site Improvements <br />Bidder: -O m ' -� otal Bid Amount: 0 77, o lS MBE Goal: s 7 <br />1 - Page I 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 />Submitted by. e �� PAs c�vxk ( <br />Print Name Sign e <br />***Goals should be c culated based on the Base Bid only.*** <br />Date <br />