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I <br /> I .., <br /> Washington State Disadvantaged Business <br /> verjr Department o ortation Enterprise Utilization Certification <br /> ITo be eligible for Award of this Contract the Bidder shall fill out and submit,as a supplement to Its sealed Bid Proposal, <br /> a Disadvantaged Business Enterprise(DBE)Utilization Certification.The Contracting Agency shall consider as non- <br /> responsive and shall reject any Bid Proposal that does not contain a DBE Utilization Certification which properly <br /> I demonstrates that the Bidder will meet the DBE participation requirements in one of the manners provided for in the <br /> proposed Contract.Refer to the Instructions on Page 2 when filling out this form or the Bld may be rejected.An <br /> example form has been provided on Page 3.The successful Bidder's DBE Utilization Certification shall be deemed a <br /> part of the resulting Contract. <br /> I Box 1: A Plus Construction Company certifies that the DBE firms listed below have been contacted <br /> regarding participation on this project.If this Bidder is successful on this project and is awarded the Contract,it shall <br /> assure that subcontracts or supply agreements are executed with named DBEs.(if necessary,use additional sheets.) <br /> Box 2: US 395,Spokane City Limits to Stevens County Line-Paving and Safety <br /> IColumn 1 Column 2 Column 3 Column 4 Column 5 <br /> Name of DBE Project Role Description of Work Dollar Amount Dollar Amount <br /> See Instructions) See instructions) See Instructions) Subcontracted to be Applied <br /> Ito DBE See Ins Towards Goal <br /> instructions) See instructions) <br /> A Plus Construction I'rime Asphalt and concrete paving,asphalt milling,prelevcling NIA 900,000 <br /> Company and pavement repair <br /> IIn the Line Services,Inc. Subcontractor(Force Crack sealing 20.000 10.000 <br /> Accowtt) <br /> In the Line Services,Inc. Subcontractor Guideposts.joint seal,pavement markers,temporary 200.000 200,000 <br /> sigttagc,construction sign installation <br /> I <br /> The Regular Dealer Rental and sales of highway construction and related I00,000 60,W 0 <br /> Everything Guys,LLC equipment and materials <br /> Optimus Prinz Trucking. Subcontractor Dump Trucking 50,000 50,000 <br /> Inc. <br /> IMetalbeads,Inc. Manufacturer Dowel Bars 75,000 75,000 <br /> Erosion Under Control Broker Erosion control blankets,straw bales and wattles,sand bags 15.006 250 <br /> Co, <br /> 1 <br /> I V)C-issi-- . <br /> I .. 8--V.N. <br /> 1 <br /> Disadvantaged Business Enterprise 356,968.1.6 Total DBE Commitment Dollar Amount 1,295,250 <br /> Condition of Award Contract Goal Box 3 Box 4 <br /> I 5 n By checking Box 5 the Bidder is stating that their attempts to solicit sufficient DBE participation to meet <br /> the�I A Contract goal has been unsuccessful and good faith effort will be submitted in accordance with <br /> Section 1-02.9 of the Contract <br /> I DOT Form 272-056 <br /> Revised 0212018 <br /> I 2023 FEDERAL OVERLAY <br /> FEDERAL AID#STBGUL-2715(011) <br /> WO#3788 March 2,2023 129 <br /> lrovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />