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CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-1.0 M5 <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 lister{ minority or woman business meets the MBE qualifications. <br />'*Goals should be calculated based on the Base Quote only.*** <br />Project Number: 124-049 Project Name: 2024 Microsurfaci <br />Bidder: q } Q&tO►" Total Bid Amount: <br />LLC <br />Quote <br />MBE Goal: NIA <br />Page of <br />Name & Address of MBE <br />Primary Contact Person <br />(Name/Telephone) <br />Scope of Work to be Performed <br />(Attach scopelschedule if you need additional space) <br />Dollar Amount of MBE <br />Component <br />Percentace <br />of Tatar <br />-Bid/Proposal <br />4 <br />Submitted by: <br />Vern+on 3/152024 <br />I <br />Print Name Signature <br />***Goals should be calculated based on the Base Quote only."*" <br />Page - 22 Public Works Quote <br />Date <br />Scanned wish CamScanner <br />