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I <br /> DISADVANTAGED BUSINESS ENTERPRISE WRITTEN CONFIRMATION DOCUMENT <br /> maimizzi Washington State Disadvantaged Business Enterprise (DBE) <br /> VI/ Department of Transportation Written Confirmation Document <br /> See('ontract Provisions: DBE Document Submittal Requirements <br /> Disadvantaged Business Enterprise Participation <br /> THIS FORM SHALL ONLY BE SUBMITTED'1OA DBE THAT IS LISTED ON THE CONTRACTOR'S <br /> DISADVANTAGED BUSINESS ENTERPRISE UTILIZATION CERTIFICATION, <br /> THE CONTRACTOR SHALL COMPLETE PART PRIOR TO SENDING TO THE DBE. <br /> PART_A:'lobe comptelfd_h tht bidder , <br /> The entries below shall be consistent with what is shown on the Bidder's Disadvantaged Business Enterprise <br /> Utilization Certification. Failure to do so will result in Bid rejection. <br /> Contract Title: 2023 Federal Overlays,City of Everett <br /> Bidder's Business Nance: HM Pacific Northwest, Inc. I <br /> DBE's Business Name: G&G,Inc. <br /> Description of DBE's Work: Traffic Loops and Video Detection System Install <br /> Dollar Amount to be Applied Towards DBE Goal: $ 226,800.00 <br /> Dollar Amount to he Subcontracted to DBE*: <br /> $226,800.00 <br /> 'Optional Field <br /> PART 13:"lb be completed by the Disadvantaged Business Enterprise <br /> As an authorized representative of the Disadvantaged Business Enterprise. I confirm that we have been <br /> contacted by the Bidder with regard to the referenced project for the purpose of performing the Work described <br /> above. I I the Bidder is awarded the Contract, we will enter into an agreement with the Bidder to participate in <br /> the project consistent with the information provided in Part A of this limn. <br /> Name(printed): Bonnie Graham <br /> Signature: `—~ I <br /> Title: President <br /> Address: 18044 SE 224th St, Date: 04/03/2023 ' <br /> Kent, WA 98042 <br /> DOT form 422-031 <br /> Revised 0T(2016 <br /> 2023 FEDERAL OVERLAY <br /> FEDERAL AIDU STBGUL-2715(011) <br /> WOt$3788 March 2,2023 130 <br />