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1,ocalAssistaneehoiceduresManual lixhibitlo-02 Cousultant Contract DBE. Commitment INSTRUCTIONS — CONSULTANT, CONTRACT DBE C:OMMTPMENT CO Sl1T TAIVT SECT QN L L,ocat Agency - Enter the name cif the local or regional agencythat is fording the contract. 2. Contract DBE Goal -Enter the coati^,actDBE goal percentage as it appears on theprojeet advertisement. 3. Project Description - Enterthe project description as it appears on the project advertisement (Bridge Rehab, Seismic $ehab, Qverlay, Widening, cic). 4. Project Location -Enter the project location as it appears on the project advertisement, 5, Consultant's Name-'Euterthoconstiltant's firm name; 6. Prime Certified DUE - Check buX if prime contractor is a certified I IL R 7. Total Con tract Award Amount-13merilre total contract award dollar amount for thepriineconsultant. 8. Total Dollar Amount for ALL Sulrcousultauts —Enter the total dollar amoumt for all Sribeuntracted eousultaaits. SUM m ,(DBEs # all Non=DBEs). Do not include the prune consultant information iu this count: 9. Total number of ALL subconsultants —Enter the total number of all subcontracted consultants. SUM = (DBEs all Non -DBEs). Do not includo theprime cot ialtaut information inthis count, 10, Description of Work, Services, or )Materials Supplied -Enter description of Nvork, services, or matey ials to be provided. Indicate all Well to be performed byDBEs inchiding work performed by the prime consultant's own forces, if the prime is a DBE. If 140% of the item is.not to be performed or iuniishodby the DBE,.describe the cxact portion to be performed or furnished by the ])Big. See LAPM Chapter 9 to determine how to couixt the participation of DBE fu`r af. 11, DBE Certificatlou Numbor - Enter the DBE's Certifications Identification Number, AIIIDBEs must be certified on the date bids are opened. 12. MRContact luformation - Enter"tho name. address, and phone number of at D—BE subcontracted eoz aultants. Also, enter the prifne consultant's name avid pbon xmiriber, if the prime is a DBL:, 13: D13GDollar Amomrt -`Muter the subcontracted dollar amount of the Work to be,performed or set -vice to'be provided, Include the prime consultant if the prime is a DBE. See LAPM t hapter.9 for• how to taunt full/partial participation, 14. Total Claimed DBE Participation - $: Enter the total dollar amounts entered in the `DBE )Dollar Amount" column, %. Enter the total DBE participation claimed ("Total Participation Dollars. Clainted"divided by item "Total Contract Award Amount"). If the total a/a claimed is less than item "Contract DBE Goat," an adequately documented Good Faith Effort (GFE) is required (see Fxhibit 1 S-11 D13I Information -Good Faith Efforts of the LAPM), 15: Preparer's Signature - "The person completing the DBE commitment form on Wulf of the consultant's firm must sign their name 16. Date - Enter the date the DBE commitment form is signed by the cox strltaut's pieparer: 17. Preparer's Name - Enter the name of the person preparing and signing the consultant's DBE commitment' form, 18. Plume -,Enter the area cote and "phone number of the person signing the consultant's MEcommitment form. 19. Preparer's Title - Enter the positionititle, of the person signing the consultant's DBE commitment form, LOCAL AGE SECTION 20. Local Agency Contract Number - Enter the Local Agency contract number or identifier. 21. Fcderai-Aid Project Number - Enter the Federal -Aid ProjectNumber, 22. Contract Execution Date - Enter the date the contract was executed; 23. Local Agency Representative's Signature - The person completing this section of thc'form for the Local Agency must sign their name to certify that die information in this and the Consultant Section of this form is complete and accurate. 24. Date - Enter the date the DBE commitment form is signed by the Local Agency; Representative.. 25. Local Agency Representative's Name - Enter the name of the Local Agency Representative certifying the consultant's DBE commitmentfoiri. 26. Phone - Enter the area code and phone number of the person signing the. consultant's DBE commitment form. 27. Local Agency Representative Title - Enter the position/title of the Local Agency Representative certifying the consultant's DBE commitment form..