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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 18-6903 <br />HAZARD AVENUE PROTECTED BIKE LANES <br />FEDERAL PROJECT NO: CML-5063 (182) <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: <br />3. Project Description: Hazard Avenue Protected Bike Lanes <br />4. Project Location: <br />n Euclid Street to Harbor Bc <br />5. Bidder's Name: HYM Enalneerinp Inc. 6. Prime Certified DBE: 0 7. Bid Amount: <br />8. Total Dollar Amount for ALL Subcontractors: <br />9. Total Number of ALL Subcontractors: <br />z <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 dale bids are opened) <br />14. DBE <br />Dollar <br />Amount <br />1119, <br />6~& work <br />38719 <br />APAWMJ&u,,l <br />(� 16& <br />-rofpc Loop, <br />38033 <br />ltj� -Jah ge4 01 714-,�04Ai <br />A4 goo <br />Local Agency to Complete this Section <br />$ /� <br />21. Local Agency Contract Number: <br />22. Federal -Aid Project Number: CML 5063 (182) <br />23. Bid Opening Date: February 26, 2020 <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />D2 .y <br />24. Contract Award Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />regardless of tier. Names of the First Tier DBE Subcontractors and <br />25. Award Amount: <br />_ <br />their respective item(s) of work listed above must be consistent, <br />where applicable with the names and Items of the work in the <br />"Subcontractor List" submitted with your bid. Written confirmation of <br />each listed DBE Is required. <br />Local Agency certifies that all DBE certifications are valid and information on <br />this form is complete and accurate. <br />2/26/2020 <br />26. Local Agency Representative's Signature 27. Date <br />16. Preparer's Signature 17. Date <br />Abraham Jeon 714-523-2372 <br />28. Local Agency Representative's Name 29. Phone <br />18. Preparer's Name 19. Phone <br />President <br />30. Local Agency Representative's Title <br />20. Preparer's Title <br />DiSiRiou iON; i. ungmai - Local Agency <br />2. Copy - Caltrans District Local Assistance Engineer (DLAE). Fallure 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- <br />6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95B14. <br />141 <br />