Always Active Services 1/23/2023

I ' ft wast��ngton state Disadvantaged Business Enterprise (DBE) 11 -71 Department of Transportation Written Confirmation Document I See Contract Provisions: DBE Document Submittal Requirements Disadvantaged Business Enterprise Participation THIS FORM SHALL ONLY BE SUBMITTED TO A DBE THAT IS LISTED ON THE CONTRACTOR'S IDISADVANTAGED BUSINESS ENTERPRISE UTILIZATION CERTIFICATION. THE CONTRACTOR SHALL COMPLETE PART A PRIOR TO SENDING TO THE DBE. I PART A: To be completed by the bidder IThe entries below shall be consistent with what is shown on the Bidder's Disadvantaged Business Enterprise Utilization Certification. Failure to do so will result in Bid rejection. ' Contract Title: Fleming Bicycle Corridor Bidder's Business Name: Always Active Services LLC IDBE's Business Name: 14i t;�f o&I - hc4 ve il u S (IL Description of DBE's Work:-Tif73 ct V1 , S 19 Y1 in, (k. I(.f I U4`,, el o i do (or I I r 01(1 NI- J Dollar Amount to be Applied Towards DBE Goal: S L1 1, Oti 0 IDollar Amount to be Subcontracted to DBE*: 'Optional Field PART B: To be completed by the Disadvantaged Business Enterprise As an authorized representative of the Disadvantaged Business Enterprise, I confirm that we have been Icontacted by the Bidder with regard to the referenced project for the purpose of performing the Work described above. If the Bidder is awarded the Contract, we will enter into an agreement with the Bidder to participate in the project consistent with the information providedin Part A of this form. ' Name (printed): tklin iCdO JChf ►,u, 1 dii Signature: '� I Title: QLk1 Mr Address: (2311 NrE key Si— Date: I I /1 3 / Z2-- I SA CkiilL WAS dCI' 11S- I I DOT I Form 422-031 Page 15 of 30 Revised 0712016 ro..; 1 d to R,,;11po-c F.xchanae of WA. Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale