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.a i\ ill Gf, <br />a <br />CITY OF SOUTH BEND !J� <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 <br />Bidder: <br />125-017R <br />Project Name <br />Urban free Nursery Site Improvements <br />Total Bid Amount: `� ?j�% 3� 7 MBE Goal: /o <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 />Gomponert <br />Percentage <br />of Total <br />BkUProposal <br />-Mvl-C SL� C <br />C-0��� <br />�e <br />e ?S <br />Submitted by: & ire <br />r Scv�GI'/'C1�/ <br />`'"'" <br />_ 7�7��,�� <br />Print Name <br />Signature <br />Date <br />***Goals should be calculated based on the Base Bid only.*** <br />