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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 16-B — SUBCONTRACTING REQUEST <br />Local Assistance Procedures Manual <br />Exhibit 16-B <br />CONTRACTORNAME HYM Engineering, Inc. <br />COUNTY Orange <br />ROUTE <br />BUSINEss ADDRE9s 1559 W. Commonwealth Ave. <br />CONTRACTNUMBER 18-6903 <br />CITY AND STATE Fullerton, CA <br />ZIP CODE 92833 <br />FEDERAL -AID PRojECrNUMBER <br />CML-5063 182 <br />A, SUBCONTRACTOR <br />B. BIDITEM <br />C. PERCENTAGEOF <br />D. SUB LISTED <br />E, CERTIFIED <br />F. DESCRIBE WORK <br />G. DOLLAR AMOUNT <br />(Narne,Bnsiness Addrm,Phone) <br />NUMBERS) <br />BID ITEM <br />AT BIDTIME <br />USE <br />WHEN LESS TITAN <br />BASEDONTHEBID <br />SUBCONTRACTED <br />100% OF WORK IS <br />AMOUNT <br />SUBCON'fRAcrEE�D <br />Yes No <br />Y�7 <br />Yes No <br />p <br />Yes No <br />Yes No <br />kl S P Cain <br />01� U�C <br />Yes No <br />Yes No <br />qR w�. <br />eoH11 <br />//Q 1-4 <br />Yes No <br />Yes No <br />/S /15 <br />❑ ❑ <br />❑ ❑ <br />i{% 4 <br />Yes No <br />Yes No <br />uY 1j <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 />incorporated in any lower -tier subcontract. Written contracts have been executed for the above noted subcontracted <br />work. <br />Contractor Signature Date /7 <br />0 <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 16-11) <br />4. Bid items subcontracted (this request) <br />5. Total bid items subcontracted (line 3 plus 4) <br />6. Balance of work contractor to perform (line 1 minus 5) <br />Approved <br />RESIDENT ENGINEEIYS SIGNATURE DATE <br />i opy utsmounon : Ongmai-contractor Copy- Resident Engineer Copy- OBEO- smallbusinessedvucate®dopt ca eov or fax to (916) 324-1949 <br />Page 1 of 2 <br />January 2018 <br />