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J IH k, <br />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 or woman business meets the MBE qualifications. <br />***Goals should be calculated based on the Base Bid only.*** <br />Project Number: 125-038 Project Name: Demolition of 4022 Old Cleveland Ro��a11d�� <br />Bidder: 4(7h Total Bid Amount: 00 MBE Goal: 1.3% <br />Page_L_of� <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 Totalgid/Pro oral <br />Kem ow <br />// <br />✓fKin <br />�-f0l <br />y - f 7 <br />/7 . <br />� , <br />5�3, o0 <br />/, 3 <br />Submitted by: k i <br />Prig Name Silty ture Date <br />***Goals should be calculated based on the Base Bid only.*** <br />Version 3/15/2024 Page - 86 Public Works Quote <br />