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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 16-B — SUBCONTRACTING REQUEST <br />Local Assistance Procedures Manual <br />Exhibit 16-13 <br />CoNTRAcroRNAME <br />COUNTY <br />ROUE <br />International Line Builder's Inc. <br />Oran a County <br />BUSINESSADDRESS <br />CONTRAcrNUMBER <br />3955 Temescal Canyon Road <br />17-6894 <br />CITY AND STATE <br />ZIP CODE <br />FEDERAL -AID PRO1Ecr NUMBER <br />Corona CA <br />92883 <br />HSIPL 5063 171 <br />A- SUBCONTRACTOR <br />B. BID ITEM <br />C. PERCENTAGE OF <br />D. SUB LIsm <br />E. CERTIFIED <br />F. DESCRIBE WORK <br />G. DOLLAR AMOUNT <br />(Name, Busmeas Address, Ptame) <br />NUMBER (s) <br />BID ITEM <br />AT BID TIME <br />DBE <br />WHEN LESS THAN <br />BASED ON THE BID <br />SUBCONTRACTED <br />100% OF WORK IS <br />SUBCONTRACTED <br />AMOUNT <br />r¢ctnv}e,LR <br />13 <br />1L]go <br />Yes No <br />�( <br />Yes No <br />�,( <br />ims-llhy 4 <br />t�,ofSO•W <br />L}ICI ci�-Itl�cl'�o' <br />u ❑ <br />u <br />•rsa 11 �l.lfirl eu--C vtJ <br />�grlye,,in <br />Aq.1 16, <br />It& <br />Q5"10 <br />Yes No <br />1 <br />Yes No <br />d <br />It9C1pf <br />Q�4J3o.Ov <br />}l�l,rlq}-C155LP <br />E ❑ <br />❑ <br />,�t�l�lsp'z�an.�6t' LA if n <br />1..�`•'—' •('t, (!� Q <br />IF <br />�.�1,13 <br />�l��o <br />Ye No <br />Y ❑ <br />Yes No <br />❑ / <br />s(A�l-Q <br />p �C.�, IU3•�l7 <br />ZweAsItlU Dvi.4 <br />f 1�2 <br />Ll <br />4��o <br />Yeses( No <br />Yes No <br />DICdI(J1C.� sw <br />�,Goozc <br />5)1)� SPA- <br />U ❑ <br />❑ <br />DQ•+tltns�+ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />I certify that: <br />• The Standard Provisions for labor set forth in the contract apply to the subcontracted work. <br />• ff applicable, Form FHW�7.�73 of the Special Provisions has been inserted in the subcontracts and should be <br />incorporated in any to er-ti/} subcontract. Written contracts have been executed for the above noted subcontracted <br />work. <br />Contractor Signature <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-B) <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 />$ <br />Approved <br />RESIDENT ENGINEER'S SIGNATURE DATE <br />Copy Distribution: Original -Contractor Copv- Resident Engineer Copv- OBEO- , )Abusinmsadvocate®dnptca.eov or fax to (916) 324-1949 <br />Page 1 of 2 January 2018 <br />?999 t�4 <br />