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CITY OF SOUTH BEND t'I <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN <br />FORM MBE-1.0 <br />MBE UTILIZATION PLAN <br />This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects <br />involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE <br />qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 123-063R Project jName: Cleveland Road <br />Bidder: � L 5i4 � 4, Total Bid Amount: <br />MBE Goal: 1.57% <br />Page of <br />Name &Address of MBE <br />Primary Contact Person <br />(Namelrelephone) <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 />az s�h4s COO( <br />rLU <br />S�S�`ocI� <br />��8,��o.OV <br />5510 <br />-� �U <br />Submitted by: �IIYw �N �� �� <br />Print Name Signat re Date <br />Version 5/20/2024 Contractors Bid for Public Works - 9 <br />