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�'A i1± <br />CITY OF SOUTH BEND �'- <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM WBE-1.0 <br />WBE UTILIZATION PLAN <br />I his 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 woman -owned business meets the WBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: <br />Bidder: <br />123-014R <br />Project Name: Demolition of 1000 West Sample Street <br />Base Bid Amount: WBE Goal: 4.65% <br />Page of <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 />L,4evrr+l0i�veXYGro�s�;�,W C,17*0 L <br />n <br />qgo jr, , SryPkwy, <br />Cwoloee� <br />1+ Pen�lcoed <br />�11-41,Gmdi Lod <br />My�vsee,% M <br />I ®®0 <br />Submitted by: C r• f l; �+� <br />Print Name <br />Signature <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 07/19/2023 Contractor's Bid for Public Works - 9 <br />Date <br />