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CITY OF SANTA ANA RE -BID <br />PROPOSAL <br />PROJECT NO.: 17-6876 <br />CROSSWALK UPGRADES PHASE II <br />FEDERAL PROJECT NO: HSIPL 5063(186) <br />EXHIBIT 16-B - SUBCONTRACTING REQUEST <br />Local Assistance Procedures Manual Exhibit 16-B <br />CONTRACPORNAMF. <br />COUNTY <br />ROUTE <br />BUSINESS ADDRE_SN <br />CONTEACTNUMBER <br />Crry AND STATE <br />`L.IPCODE <br />FEDERAL -AID Ptaxscr NUMBER <br />A. STIRCONERACTOR <br />B. Bm ITEM <br />C. PERCENTAGEOF <br />D. SUB LISTED <br />E. CERTIFIED <br />F. DFSCRmF. WORK <br />G. DOLLAR AMOUNT <br />(Name, Busi ss Address, Phone) <br />NUMBERS) <br />BIDITEM <br />AT BID TIME <br />DBE <br />WDPFr Ixss THAN <br />BASF.DONTHEBID <br />SUBCONTRACTED <br />100% OF WORK TS <br />AMOUNT <br />SUBCONTRACTED <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />I certify that: <br />• The Standard Provisions for labor set forth in the contract apply to the subcontracted work. <br />• If applicable, Form FHWA-1273 of the Special Provisions has been inserted in the subcontracts and should be <br />incorporatedin any lower-ber subcontract. Written contracts have been executed for the above noted subcontracted <br />work. <br />Contractor Signature Date <br />This section is to be completed by the resident engineer. <br />1. Total of bid items <br />2. Contractor must perform with own forces (line 1 X contract req. %) <br />3. Bid items previously subcontracted (taken from previously approved 16-B) <br />4. Bid items subcontracted (ads request) $ <br />5. 'Finat bid items subcontracted (line 3 plus 4) <br />6. Balance of work contractor to perform (line 1 minas 5) <br />RESIDENT ENGINEEWSSIGNATURE <br />Copy Distribution:Original-Conractur Copy- Resident Engineer Copy-OBF.O- snral lbusinessadvucatogdolzEcavv,)i. or fax to(916) 324-1949 <br />Page 1 of 2 <br />January2018 <br />d iPf 154421 RE -BID <br />