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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6875 <br />CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES <br />FEDERAL PROJECT NO: HSIPL 5063(188) <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: <br />3. Project Description: Citywide Traffic Signal Vehicle Head Upgrades <br />4. Project Location: Citywide <br />5. Bidder's Name: International Line BUIIder's, Inc. 6. Prime Certified DBE: ❑ 7. Bid Amount: 4309,05q.60 <br />8. Total Dollar Amount for ALL Subcontractors: a 9. Total Number of ALL Subcontractors: <br />10. Bid <br />Item <br />Number <br />11. Description of Work. Service. or Materials <br />Supplied <br />12. DBE <br />Certification <br />Number <br />13. DBE Contact Information <br />(Must be certified on the date bids are opened) <br />14. DBE <br />Dollar <br />Amount <br />3 <br />r leca ruczjl ti l ater�ra It <br />yoSNo <br />7E17- d e 2"`= ►.L OI po ba,4 2f LP <br />I "U, tLq�o <br />7itlli�l ILa111ah (}ICI �'�Cp- �I10 <br />=$.�1,N6+J. <br />Local Agency to Complete this Section upon Execution of Award <br />s3�1,�8 <br />21. Local Agency Contract Number: <br />22. Federal -Aid Project Number: HSIPL 5063(188) <br />23. Bid Opening Date: October 30. 2019 <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />a G� <br />24. Contract Award Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit. <br />25. Award Amount: <br />regardless of tier. Names of the First Tier DBE Subcontractors and <br />their respectiv items) of work listed above must be consistent. <br />where appli le with the names and items of the work in the <br />"Subcontr t List" submitted with your bid. Written confirmation of <br />each list E is r quire . <br />Local Agency certifies that all DBE certifications are valid and information on <br />this form is complete and accurate. <br />10/30/2019 <br />26. Local Agency Representative's Signature 27. Date <br />16. Preparer's Signature 17. Date <br />at¢n�-fl- 8¢ww, (951) 682-2982 <br />28. Local Agency Representative's Name 29. Phone <br />18. Preparer's Name 19. Phone <br />30. Local Agency Representative's Title <br />llde)b.l'O alai DtJ- <br />20. Preparer's Title <br />DISTRIBUTION: 1. Original - Local Agency <br />2. Copy- Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract <br />execution may result in de -obligation of federal funds on contract. <br />3. Include additional copy with award package. <br />ADA Notice: For individuals with sensory disabilities. this document is available in alternate formats. For information call (916) 654-6410 <br />or TDD (916) 654-3880 or write Records and Forms Management. 1120 N Street. MS-89. Sacramento. CA 95814. <br />?o A9 <br />