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� 4SpUTH B��d <br />CITY OF SOUTH BEND d <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN x�`:_, ." <br />FORM MBE-1.0 <br />1865 <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 />Project Number: 123-042 Project Name <br />Bidder: Larson -Danielson Const. Co., Inc. <br />Century Center North Restroom Renovation <br />Total Bid Amount: MBE Goal: 0.5% <br />Page 1 of 1 <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 />No Quotes from this Specific Scope <br />Submitted by: Brian T. Larson, President <br />Print Name <br />Signature <br />LARSON-DANIELSON <br />senL ) CONSTRUCTION CO., INC. <br />5/23/23 <br />Date <br />Version 03/15/2023 Page - 20 Public Works Quote <br />