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CITY OF SOUTH BEND <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 involving MBE participation. It is <br />the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 124-023A Project Name: Potawatomi Park Imprr-ov9ements Pool House Demolition <br />Bidder: Total Bid Amount: Tjr o� ialoj MBE Goal: 1.26% <br />Page_ 1 of j <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/Pro osal <br />,*y <br />r <br />-�-- <br />Submitted by: 4 � ` r - f ..r �� ,�°''r �•b• ,�' <br />Pria Name �,> Signature Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 5/20/2024 Contractor's Bid for Public Works - 8 <br />