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Revised 09/2020 <br /> Disadvantaged Business Enterprise (DBE) Bid Item Breakdown Form <br />1. Contract Number 2. Contract Name <br />3. Prime Contractor 4. Prime Contractor Representative Name <br />5. Prime Contractor Representative Phone Number 6. Prime Contractor Representative Email <br />Column 1 <br />Name of UDBE(See Instructions) <br />Column 2 <br />Bid Item #(See Instructions) <br />Column 3 <br />Full/Partial(See Instructions) <br />Column 4 <br />Quantity(See Instructions) <br />Column 5 <br />Description(See Instructions) <br />Column 6 <br />Unit Price(See Instructions) <br />Column 7 <br />Total Unit <br />Cost(See Instructions) <br />Column 8 <br />Dollar Amount <br />to be Applied <br />Towards Goal(See Instructions) <br />Subtotal: <br />Name of UDBE Bid Item # Full/Partial Quantity Description Unit Price <br />Total Unit <br />Cost <br />Dollar Amount <br />to be Applied <br />Towards Goal <br />Subtotal: <br />Name of UDBE Bid Item # Full/Partial Quantity Description Unit Price <br />Total Unit <br />Cost <br />Dollar Amount <br />to be Applied <br />Towards Goal <br />Subtotal: <br />Name of UDBE Bid Item # Full/Partial Quantity Description Unit Price <br />Total Unit <br />Cost <br />Dollar Amount <br />to be Applied <br />Towards Goal <br />Subtotal: <br />TOTAL UDBE Dollar Amount: <br />DOT Form 272-054 <br />0 0 <br />0 0 <br />0 0 <br />0 0 <br />0 0