INTERNATIONAL LINE BUILDERS, INC.

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CITY OF SANTA ANA PROPQSAL, PROJECT NO.: 17-6875 CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES FEDERAL PROJECT NO: HSIPL 5063(188) INSTRUCTIONS CONSTRUCTION CONTRACT DBE COMMITMENT VLNTRAC.T R SECTION 1. Local Agency - Enter the name of the Iocal agency that is administering the contract. 2. Contract DBE Coal -Enter the contract DBE goal percentage as it appears on the project advertisement. 3, Project Location -Enter the projectlocation(s) as. it appears on the project advertisement. 4. Project Description . Enter the project description as it appeals oritbe project advertlseurem(Bridge Rehab, Seismic Rehab, Overlay,Vvddening, etc). S. Bidder's Name - Enter the contractor's firm name, 6. Prime Certified DBE . Check box ifprimc contractor is a certified DBE. 7. Sid Amount - Enter the total contract bid dollar amount for the prime contractor; S. Total Dollar Amount for ALL Subcontractors — Enter the total dollar amount for all subcontracted contractors. SUM= (DBEs + all .Non -DBEs), Do not include file prime contractor information in this count. 9. Total number of ALLLL subcontractors — Enter fire total number of all subcontracted coutractors, SUM— (D$Es +all Non - DBEs), Do not Include the prime contractor information in this count. 10, Bid Item Number-Bnterbid item number for work, services, or materials supplied to be provided. .1I. Descriptiion of Work, Services, or Materials Supplied -Enter description of work, services, or materials to be provided, indicate all work to be performed by DBEs including work performed by the prime contractor's own forces, if the prime is a 'DBE. If 100%of the item is not to be performed of tomished by the DBE, describe the exact portion to be performed or furnished by the DBE. See LAPM Chapter 9 to determine how to count the participation ofDBE f ins. 12. DBE Certifleadon Number - Enter the DBE's Certification Identification Number. All DBEs must be certified on the (late bids are'opened, 13, DBIR Contact Information - Enter the name, address, and plume number of all DBE subcontracted contractors. Also, enter the prime contractor's naine and phone pumbec, ifthe prime is a DBE, 14. DBEDollar Amount -'Bator the subcontracted dollar amount of the work to be perfemred or service tape provided, include the prime contractor if the prime is DBE. See LAPM Chapter 91irr how to coot Tull/partial participation. 15, Total Claimed DBE Participation - $: Enter the total dollar amounts entered in the "DRE Dollar Amount" columm. %l , Filter the total DBE participation claimed.("Total Claimed DBE Participation Dollars" divided by item "Bid Amount"), If the total "Yo claimed is less than item "Contract DBE Goal," an adequately documented Good Faith Effort (OFE) is required (see Exhibit 15- H,DBE Information - Good Faith Efforts of the LAPM). 16. Preparer's Signature - The person completing the DBE commitment form on behalf of the contractor's firm must sign their name. 17. Date - Enter the dale the DBE commitment form is signed bythe .coon actor's preparers III. Preparer's Name - Enter the name ofthe person preparing and signing the. contractor's DBE -commitment form. 19. Phone- rotor the area code and phone number of the person signing the contractor's DBE commitment form. 26. Preparer's Title - Enter the position/dile of tile person signing the contractor's DBE commitment form. LOCAL: AGENCY SECTION 21. Local Agency Coutract Nurnber -Ewer the Local Agency controot number or identifjer. 22, Federal -Aid Project Number -Eme the Fedarai-Aid ProjectNumber(s). 23, Bid Opening Date - Enter the date contract bids were opened, 24, Contract. Award Date- Enter the date the contract was executed. 25. Award Amount - Enter the contract award amount as stated in the executed contract. 26, Local Agency Reproserrtative's Signature - The person completing this section of the form for the Local Agency must sign their nameto certify that the information In this and die Contractor Section of this form is complete and accurate: 27, Date -Enter the date the DBE commitment form is signed by the Local Agency Representative. 28. Local Agency Representative's Name - Enter the name of the Local Agency Representative certifying the contractor's DBE commitment form. 29. Phone - Enter die area code and phone number of the person signing the contractor's DBE commitment form. 30. Local Agency Representative Title -.Enter the position/title of the Local Agency Representative certifying the contractor's. DBE commitment form, P-26 of P-38