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I <br /> ' 1 12 Washington State Underutilized Disadvantaged Business <br /> / Department of Transportation Enterprise (UDBE) Bid Item Breakdown Form <br /> 1.Contract Number 2.Contract Name <br /> I WO#3788 2023 Federal Overlay <br /> 3.Prime Contractor 4. Prime Contractor Representative Name <br /> HM Pacific Northwest, Inc. Satya Kammanenadimenti <br /> I <br /> 5. Prime Contractor Representative Phone Number 6.Prime Contractor Representative Email <br /> 206-867-0883 satya.kammanenadimenti@heidelbergmaterials.com <br /> Column 7 Column 8 <br /> Column 1 Column 2, Column 3 Column 4 Column 5 Column 6 Total Unit Dollar Amount <br /> Name of UDBE Bid Item# Full/Partial Quantity Description Unit Price ost to be Applied <br /> (See Instructions) (See Instructions) (See Instructions) (See, Instructions) (See Instructions): (See Instructions) Towards Goal <br /> (See Instructions) <br /> (See Instructions) <br /> I <br /> G & G, Inc. 25 Full 2,600 LF Vehicle Loop Detectors $ 28.00 $72,800.00 $ 72,800.00 <br /> G & G, Inc. 26 Full 200 LF Conduit Pipe,2"Diameter $ 20.00 $4,000.00 $ 4,000.00 <br /> IG & G, Inc. 27 Full 1 LS Video Detection System $150,000.00 $150,000.00 $ 150,000.00 <br /> Alpine Development,Inc. 1 Partial 1 LS Mobilization $4,000.00 $4,000.00 $ 0.00 <br /> I Subtotal: $230,800.00 $226,800.00 <br /> Total Unit Dollar Amount <br /> Name of UDBE Bid Item# Full/Partial Quantity Description Unit Price Cost to be Applied <br /> Towards Goal <br /> Alpine Development,Inc. 14 Partial 13 EA Adjust Manhole To Grade $ 550.00 $ 7,150.00 $ 2,145.00 <br /> Alpine Development,Inc. 15 Partial 18 EA Adjust Catch Basin/Inlet To Grade $ 300.00 $ 5,400.00 $ 0.00 <br /> IAlpine Development,Inc. 16 Partial 20 EA Adjust Water Valve Box to Grade $ 550.00 $11,000.00 $ 3,300.00 <br /> Alpine Development,Inc. 17 Partial 12 EA Adjust Existing Monument Casting To Grade $ 550.00 $6,600.00 $ 1,980.00 <br /> ISubtotal: $30,150.00 $7,425.00 <br /> Total Unit Dollar Amount <br /> Name of UDBE Bid Item# Full/Partial Quantity Description Unit Price Cost to be Applied <br /> I <br /> Towards Goal <br /> I <br /> ISubtotal: $0.00 $0.00 <br /> I <br /> Total Unit Dollar Amount <br /> Name of UDBE: Bid Item# Full/Partial Quantity Description Unit Price Cost to be Applied <br /> Towards Goal <br /> I <br /> I <br /> Subtotal: $ 0.00 $0.00 <br /> ITOTAL UDBE Dollar Amount: $260,950.00 $234,225.00 <br /> DOT Form 272-054 Revised 01/2020 <br /> 1 2023 FEDERAL OVERLAY <br /> FEDERAL AID#STBGUL-2715(011) <br /> WO#3788 March 2,2023 131 <br />