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CITI' OF SANTA ANA <br />PROPOSAL <br />PROJECT NO,: 17-6875 <br />CITYWIDE TRAFFIC SIGNAL VEHICLE DEAD 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 8% <br />3. Project Description: Citywide Traffic Signal Vehicle Head Upgrades _ <br />4, Project. Location; <br />5. Bidder's Name; International Line Builder's, Inc. 6. Prime Certified DBE: I] 7, Bid Amount: 4300 050'ap <br />8. Total Dollar Amount for ALL Subcontractors: g, Total Number of ALL Subcontractors: f <br />10 Bid <br />Itom <br />Number <br />11, Description of Work. Service. or Materials <br />Supplied <br />12 DBE <br />Certification <br />Number <br />� <br />13. DBE Contact Information <br />(Must be certified on the date bids are opened) <br />14. DBE <br />Dollar <br />Amount. <br />F1P-dy (.,V1 "Clletl44If <br />go5go <br />16114— ar ��� ",rm LP <br />uLtlitY Itzll��t��4'2rGD• la <br />$taLo,w 0A <br />qb <br />=$�I,"18�f, <br />Local 4Agency to Complete this Section upon Ezacutionnf Award <br />16. TOTAL CLAIMED DBE PARTICIPATION <br />�`��'� <br />27. Local Agency Contract Number; � <br />22. Federal-Ald Project Number: HSIPL 6063(188) <br />23. Bid Opening Date: October 30 2019 ___. <br />` a� <br />._...._.._........ .,_......._........_.._. <br />IMPORTANT. Identify all DBE firms being claimed for credit, <br />24. Contract Award Date:- <br />25, Award: Amount: <br />regardless of tier. Names of the First Tier DBE Subcontractors and <br />respeclly ilem(s) of work listed above must be consistent. <br />where appal le with the names and Items of the work In the <br />' Subcontr t List" su Itted with your bid. Written oonifrmaHon of <br />each list E is r quire :.� <br />_ <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 />gc an,intl•• $ _ (51 $2-2982 <br />28. Local Agency Representative's. Name 29, Phone <br />19, Phone <br />18. Preparer's Namely <br />_ <br />�y <br />D,IIC�a'tl" o l.xlt nth'. <br />J <br />30..Local Agency Representative's Title <br />20, Preparer's Title <br />DISTRIBUTION: 1.Original — Local Agency <br />2. Copy— Coltrane District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days. of contract <br />execution mayresult In de-obtigaflon 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 formals. For Information tali (918) 664-6410 <br />or TDD (916) 654-3880 or write Records. and Forms Management. 1120 N Street. MS-89. Sacramento. CA 95814, <br />P-25 of P-38 <br />