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1 <br /> Instructions for Disadvantaged Business Enterprise(DBE)Bid Item Breakdown Form <br /> Box 1:Provide the Contract Number as stated in the project information webpage. <br /> Box 2:Provide the Name of the project as stated in the project information webpage. <br /> Box 3:Provide the Name of the bidder(Proposal holder)submitting Bid. <br /> Box 4:Provide the name of the prime contractor's representative available to contact regarding this form. <br /> Box 5:Provide the phone number of the prime contractor's representative available to contact regarding this form. <br /> Box 6:Provide the email of the prime contractor's representative available to contact regarding this form. <br /> Column 1:Provide the Name of the Disadvantaged Business Enterprise(DBE)Firm.DBE Firms can be found using the <br /> search tools under the Firm Certification section of the Diversity Management and Compliance System <br /> (DMCS)webpage https:/Jwsdot.diversitycompliance.com. <br /> Column 2:Provide the Bid Item Number(as it appears in the engineer's estimate bid check report)available on the project <br /> information webpage. <br /> Column 3:If the DBE is performing only part of the bid item,mark"Partial". If the DBE is performing the entire bid item, <br /> mark"Complete". <br /> Column 4:Provide the estimated quantity for the specific bid item.For trucking firms,use hour or another unit of measure. <br /> Column 5:Provide a description of the work to be performed by the DBE. <br /> Column 6:Provide the price per unit and specify the type of unit used.For trucking firms,use hour or another unit of <br /> measure. <br /> Column 7:Provide the estimated total unit cost amount per bid item. <br /> Column 8:Provide the amount of the bid item being used to fulfil the DBE goal.The work to be performed must <br /> be consistent with the Certified Business Description of the DBE provided in the DMCS webpage https://wsdot. <br /> diversitycompliance.com.Mobilization up to 10%is acceptable. If mobilization is more than 10%additional information <br /> and/or justification may be requested.The total amount shown for each DBE shall match the amount shown on the DBE <br /> Utilization Certification Form. <br /> Use Additional Sheets if necessary. <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> DOT Form 272-054 <br /> Revised 09/2020 <br /> 2023 FEDERAL OVERLAY <br /> FEDERAL AIDU STBGUL-2715(011) <br /> WO#3788 March 2,2023 132 <br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />