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CITY OF SOUTH BEND <br />I !-1 <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MWBE-1.0 <br />MWBE UTILIZATION PLAN <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MWBE participation. It <br />is the bidder's sole responsibility to verify whether any listed minority or woman business meets the MWBE qualifications. <br />Project Number: 120-001 Project Name: 2020 Curb and Sidewalk Construction <br />Bidder: ?44pilmAq e 72-c Total Bid Amount: y � MWBE Goal: <br />Page of <br />Name &Address of MWBE <br />Primary Contact Person <br />(NamelTelephone) <br />Scope of Work to be Per€amed <br />(Attach scope/schedule if you need additional space) <br />Dol[arAmount of MWBE <br />Camponenl <br />rcentage <br />of Total <br />�1,"ro osa[ <br />71 p�yp�� <br />E'L9MAA,r, siv V6 r®& <br />33gie) <br />Submitted by: 64,1 16C 5 -Aov� , <br />Print Name Signat re <br />Version 01/29/202G Contractor's Hid for Public Works - 10 <br />-)r- /)`�? <br />Date <br />