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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 <br />(See Instructions) <br />Column 2 <br />Bid Item # <br />(See Instructions) <br />Column 3 <br />Full/Partial <br />(See Instructions) <br />Column 4 <br />Quantity <br />(See Instructions) <br />Column 5 <br />Description <br />(See Instructions) <br />Column 6 <br />Unit Price <br />(See Instructions) <br />Column 7 <br />Total Unit <br />Cost <br />(See Instructions) <br />Column 8 <br />Dollar Amount <br />to be Applied <br />Towards Goal <br />(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 />$ 0.00 $ 0.00 <br />$ 0.00 $ 0.00 <br />$ 0.00 $ 0.00 <br />$ 0.00 $ 0.00 <br />$ 0.00 $ 0.00