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PUBLIC WORKS CONTRACT AWARD INFORMATION <br />Contract award Information must be sent to your Apprenticeship Committee if you are approved to train. If you are not approved to train, you <br />must send the Information (which may be this form) to ALL applicable Apprenticeship Committees in your craft or trade in the area of the site <br />of the public work. Go to: http:Nwww,dir.ca.gov/das/Publ!cWorksForms.htmfor Information about programs in your area and trade. You may <br />also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under <br />California, State of, Industrial Relations, Division of Apprenticeship Standards. <br />Do not send this form to the Division of Apprenticeship Standards. <br />NAME OF YOUR COMPANY <br />EBS General Engineering, Inc <br />CONTRACTORS STATE LICENSE NO <br />720016 <br />MAILINGADDRESS. NUMBER 8 STREET, CITY, ZIP CODE <br />1320 E. Sixth St. #100 Corona, CA 92879 <br />AREA CODE 8 TELEPHONE No <br />951-279-6869 <br />NAME 8 ADDRESS OF PUBLIC WORKS PROJECT <br />DATE YOUR CONTRACT EXECUTED <br />RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY <br />5/21/19 <br />IMPROVEMENT FY17/18 PROJECT <br />DATE OF EXPECTED OR ACTUAL START OF PROJECT <br />Various, City of Santa Ana <br />6/10/19 <br />NAME 8 ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT <br />ESTIMATED NUMBER OF JOURNEYMEN HOURS <br />City of Santa Ana <br />1358 <br />20 Civic Center Plaza <br />OCCUPATION OF APPRENTICE <br />Santa Ana, CA 92701 <br />Cement Mason <br />THIS FORM IS BEING SENT TO: (NAME 8 ADDRESS OF APPRENTICESHIP PROGRAM(S)) <br />ESTIMATED NUMBER OF APPRENTICE HOURS <br />Southern CA Cement Mason JAC <br />272 <br />5417 Peck Road <br />APPROXIMATE DATES TO BE EMPLOYED <br />Arcadia CA 91006 <br />6/10/19 thru 7/31/19 <br />t: 626-444-4600 <br />f: 626-258-4092 <br />This is not a request for dispatch of apprentices. <br />Contractors must make a separate request for actual dispatch, in accordance with Section 230.1(a) California Code of Regulations <br />Check One Of The Boxes Below <br />1. x We are already approved to train apprentices by the Cement Masons <br />Apprenticeship Committee. We will employ and train under their Standards. Enter name of the <br />2. ❑ We will comply with the standards of <br />Apprenticeship Committee for the duration of this job only. Enter name of the committee <br />3. ❑ We will employ and train apprentices in accordance with the California Apprenticeship Council regulations, <br />including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to <br />perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all <br />times work with or under the direct supervision of journeyman/men. <br />Signature t/l_� Date �r23d\�l <br />Typed Name <br />Title <br />Cristina Whitcher <br />Contracts Administrator <br />State of California - Department of Industrial Relations DIVISION <br />OAS 140 (REV. t04) OF APPRENTICESHIP STANDARDS <br />