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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6894 <br />EUCLID STREET AT HAZARD AVENUE SIGNAL MODIFICATION <br />FEDERAL PROJECT NO: HSIPL 5063 (171) <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: <br />3. Project Description: Install left turn phasing Traffic Signal Modification on Euclid Street at Hazard Avenue <br />4. Project Location: On Hazard Avenue at Euclid Street. �1 _,, (,� <br />5. BidderSy 's Name: tl-f.2Y1cdi cvloll Lid-O pxJICkA�L "6. Pdme Certified DBE: ❑ 7. Bid Amount: <br />8. Total Dollar Amount for ALL Subcontractors: f C1a'. olC19A.00 9. Total Number of ALL Subcontractors: <br />1It 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 date bids are opened) <br />14. DBE <br />Dollar <br />Amount <br />n.u. <br />Vul 1-ialealalf <br />goeq <br />wxfearILLd Pa 09-a�5�y <br />a La <br />rg,b�na, CJ9 Cob 5 'Jwha <br />fl I <br />too, •col <br />xuoa. <br />. <br />� <br />�tee�C.Ficnctl IlLflllny <br />465L4, <br />ew,emnde� 1 crl D121111na�; wu• <br />�*tq y e a �`'n dw ram, c Uf a <br />t �,000• dv <br />Local Agency to Complete this Section <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />21. Local Agency Contract Number: <br />H SIPL 5063 (171 <br />22. Federal -Aid Project Number: ) <br />a5. I l ^ro <br />23. Bid Opening Date: <br />24. Contract Award Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit. <br />25. Award Amount: <br />regardless of tier. Names of the First Tier DBE Subcontractors and <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 />Local Agency certifies that all DBE certifications are valid and information <br />on <br />"Subcontractor List" submitted with your bid. Written confirmation of <br />this form is complete and accurate. <br />each listed DBE is required. <br />Loll 1 /[lltih'Yly ✓A-r Cal -2YLP12-otu <br />26. Local Agency Representative's Signature 27. Date <br />16. Preparers Signat 17. ate <br />28. Local Agency Representative's Name 29. Phone <br />?W%noln "[-�V4V1Jj1e1l t! I c�s3a-aq9 <br />18. Preparer's Name 19. P one <br />30. Local Agency Representative's Title <br />t� xxodlriaf� <br />20. Preparer's Title <br />DISTRIBUTION: 1. Original - Local Agency <br />2. Copy - Caltrans District Local Assistance Engineer (DLAE). Failure 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 95814. <br />20D-38 <br />P-26 of P-39 <br />