ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
 Construction Materials & Manufactured Products De Minimis
2
Data Entry Fields
3
Project Name:
Calculated Values
4
5
Project Location:
6
PIN:
7
Form Updated 12/17/25
8
 Material Cost of (non-compliant) Items
9
Line No.Item Description and Other Pertinent Material InformationStationOffsetUnit Price from Invoice w/ Sales TaxQty Applicable Material Cost
10
1 $ - $ -
11
2 $ - $ -
12
3 $ - $ -
13
4 $ - $ -
14
5 $ - $ -
15
6 $ - $ -
16
7 $ - $ -
17
8 $ - $ -
18
9 $ - $ -
19
10 $ - $ -
20
11 $ - $ -
21
12 $ - $ -
22
13 $ - $ -
23
14 $ - $ -
24
15 $ - $ -
25
16 $ - $ -
26
17 $ - $ -
27
18 $ - $ -
28
19 $ - $ -
29
20 $ - $ -
30
21 $ - $ -
31
22 $ - $ -
32
23 $ - $ -
33
24 $ - $ -
34
25 $ - $ -
35
26 $ - $ -
36
27 $ - $ -
37
38
Total Applicable Project Cost
39
Line No.Item Description and Other Pertinent Material InformationUnit Price from Invoice w/ Sales TaxQty Applicable Material Cost
40
1 $ - $ -
41
2 $ - $ -
42
3 $ - $ -
43
4 $ - $ -
44
5 $ - $ -
45
6 $ - $ -
46
7 $ - $ -
47
8 $ - $ -
48
9 $ - $ -
49
10 $ - $ -
50
11 $ - $ -
51
12 $ - $ -
52
13 $ - $ -
53
14 $ - $ -
54
15 $ - $ -
55
16 $ - $ -
56
17 $ - $ -
57
18 $ - $ -
58
19 $ - $ -
59
60
Total cost of Non Compliant Materials: $ -
61
Total Applicable Project Cost: $ -
62
Maximum De Minimis Percentage of Total Applicable Project Cost:5.00%
63
Maximum Value of Non Compliant Materials Allowed: $ -
64
Acceptable
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100