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I <br />CITY OF SOUTH BEND <br />hL <br />.c <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN. <br />y C <br />A__,/'z <br />FORM WBE-1.0 <br />WBE UTILIZATION PLAN <br />865 <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is <br />the bidder's sole responsibility to verify whether any listed minority or woman business meets the WBE 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: WBE Goal: 1.5% <br />Page 1 of 1 <br />Name & Address of WBE <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 WBE <br />Component <br />Percentage <br />of Total <br />Bid/Proposal <br />No Quotes from this Specific Scope <br />Submitted by: Brian T. Larson, President X c 5/23/23 <br />Print Name Signature Date <br />LARSON-DANIELSON <br />pCONSTRUCTION CO., INC. <br />Version 03/15/2023 Page - 21 Public Works Quote <br />