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1 <br /> ' Ants Underutilized Disadvantaged Business <br /> 1,71la Washington State Enterprise (UDBE) Written <br /> Department of Transportation <br /> Confirmation Document <br /> See Contract Provisions: UDBE Document Submittal Requirements <br /> Disadvantaged Business Enterprise Participation <br /> THIS FORM SHALL ONLY BE SUBMITTED TO A UDBE THAT IS LISTED ON THE CONTRAC'TOR'S <br /> UNDERUTILIZED DISADVANTAGED BUSINESS ENTERPRISE UTILIZATION CERTIFICATION. <br /> THE CONTRACTOR SHALL COMPI.,ETE. PART A PRIOR TO SENDING 1'0 THE UDBE. <br /> PART A: To be completed by the bidder <br /> The entries below shall be consistent with what is shown on the Bidders Underutilized Disadvantaged Business <br /> Enterprise Utilization Certification. Failure to do so will result in Bid rejection. <br /> Contract Title: <br /> ' Bidder's Business Name: <br /> UDBE's Business Name: <br /> ' Description of UDBE's Work: <br /> Dollar Amount to be Applied Towards UDBE Goal: <br /> Dollar Amount to be Subcontracted to UDBE*: <br /> -Optional Field <br /> PART B: To be completed by the Underutilized Disadvantaged Business Enterprise <br /> ' As an authorized representative of the Underutilized Disadvantaged Business Enterprise. I confirm that we <br /> have been contacted by the Bidder with regard to the referenced project for the purpose of performing the Work <br /> described above. lithe Bidder is awarded the Contract, we will enter into an agreement with the Bidder to <br /> participate in the project consistent with the information provided in Part A of this form. <br /> Name (printed): <br /> ' Signature: <br /> Title: <br /> Address: Date: <br /> 111 <br /> 1 <br /> DoT Form 422-031U <br /> ' Revised 0212018 <br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />