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I . <br /> 1 • <br /> Washington State Underutilized Disadvantaged Business <br /> var Department of Transportation Enterprise Utilization Certification <br /> ' To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, an <br /> Underutilized Disadvantaged Business Enterprise(UDBE) Utilization Certification. The Contracting Agency shall consider <br /> as non-responsive and shall reject any Bid Proposal that does not contain a UDBE Utilization Certification which properly <br /> ' demonstrates that the Bidder will meet the UDBE participation requirements in one of the manners provided for in the <br /> proposed Contract. Refer to the instructions on Page 2 when filling out this form or the Bid may be rejected.An <br /> example form has been provided on Page 3.The successful Bidder's UDBE Utilization Certification shall be deemed a <br /> ' part of the resulting Contract. <br /> Box 1: certifies that the UDBE firms listed below have been contacted <br /> regarding participation on this project. If this Bidder is successful on this project and is awarded the Contract, it shall <br /> assure that subcontracts or supply agreements are executed with named UDBEs. (If necessary, use additional sheets.) <br /> Box 2: <br /> Column 1 Column 2 Column 3 Column 4 Column 5 <br /> ' Name of UDBE <br /> (See instructions) Project Role Description of Work Dollar Amount Dollar Amount <br /> (See instructions) (See instructions) Subcontracted to be Applied <br /> to UDBE Towards Goal <br /> (See instructions) (See instructions) <br /> II1 <br /> II <br /> 1 <br /> 1 <br /> I <br /> ' Underutilized Disadvantaged Business Total UDBE Commitment Dollar Amount <br /> Enterprise Condition of Award Contract Goal Box 3 Box 4 <br /> 5 n By checking Box 5 the Bidder is stating that their attempts to solicit sufficient UDBE participation to meet <br /> ' the COA Contract goal has been unsuccessful and good faith effort will be submitted in accordance with <br /> Section 1-02.9 of the Contract <br /> DOT Forni 272-056U <br /> Revised 0212018 <br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />