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Pellco Construction Inc <br /> Local Agency Disadvantaged Business <br /> Enterprise Utilization Certification <br /> To be eligible for award of this contract the bidder must fill out and submit, as part of its bid proposal,the following Disadvantaged <br /> Business Enterprise Utilization Certification relating to Disadvantaged Business Enterprise(DBE)requirements.The Contracting Agency <br /> shall consider as non-responsive and shall reject any bid proposal that does not contain a DBE Certification which properly <br /> demonstrates that the bidder will meet the DBE participation requirements in one of the manners provided for in the proposed contract. <br /> The Bidder must submit good faith effort documentation only in the event the bidder's efforts to solicit sufficient DBE participation has <br /> been unsuccessful. The successful bidder's Disadvantage Business Enterprise Utilization Certification shall be deemed a part of the <br /> resulting contract.Information on certified firms is available from OMWBE online at http:!/omwbe,wa.gov/directory-of-certified-firms/ <br /> Pellco Construction Inc certifies that the Disadvantaged Business Enterprise(DBE) <br /> (box 1) Name of Bidder <br /> Firms listed below have been contacted regarding participation on this project.If this bidder is successful on this project and is awarded <br /> the contract, it shall assure that subcontracts or supply agreements are executed with those firms where an"Amount to be Applied <br /> Towards Goal"is listed. (If necessary, use additional sheet) <br /> Column 1 Column 2 * Column 3 Column 4 �* <br /> Project Role Amount to <br /> Name of DBE (Prime,Joint Venture, <br /> Certificate Number Subcontractor Description of Work be Applied <br /> Manufacturer,Regular Towards Goal <br /> Dealer,Force Account) <br /> 1. Silver Streak DQ Fools‘ 1 <br /> 23/00 SE 264th Street— <br /> MV WA 981)38 sub dump trucking $25,250 <br /> 2 Outwest Landscapin —i t7 <br /> PO-Box is3� <br /> Monroe, WA 98272 sub landscaping $6,794 <br /> 3. DBE Electric Inc 1)2\per,\ �? 7_ <br /> PO Box 9169 <br /> Covington,WA 98092 cuh electrical flaship9 beams $11,66248- <br /> 4. Highway Specialties 0 2,F O O !`13 Syji,(4 <br /> PO Box 15468 'Z -.- <br /> Portland WA 98385 .;; ^+,i"O�clo traction sign $7,500 <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> *+. <br /> Disadvantaged Business Enterprise Subcontracting Goal. /Z DEE Total$ ( � /SS . 015 <br /> Box 2 / Box 3 <br /> * Regular Dealer status must be approved prior to bid submittal by the Office of Equal Opportunity,Wash.State Dept.of Transportation,on each <br /> contract. <br /> ** See the section"Crediting DBE Participation Toward Meeting the Goal"in the Contract Document. <br /> ... The Contracting Agency will utilize this amount to determine whether or not the bidder has met the goal.In the event of an arithmetic difference <br /> between this total and the sum of the individual amounts listed above,then the sum of the amounts listed shall prevail and the total will be revised <br /> accordingly. Participation in excess of the goal amount will be considered voluntary or race-neutral participation. <br /> SR <br /> DOT Form 272-058A <br /> 10/2015 <br /> rc led to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com-Always Verify Scale <br />