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C <br />CITY OF SOUTH BEND <br />MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN - <br />FORM WBE-1.0 <br />WBE UTILIZATION PLAN <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 woman -owned business meets the WBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 124-023A Project Name: Potawatomi Park Improvements Pool House Demolition <br />Bidder: �. t f " i �n.•/�/f,.� .�'�i�"r`r1i Total Bid Amount: 0 2o. �,p,•-t �9 ,�' WBE Goal: 4.56% <br />Page / of I <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 />Submitted by:An f �i F11%,sr'`Y "l, - <br />PrintName Signa re Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 5/20/2024 Contractor's Bid for Public Works - 9 <br />