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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6876 <br />CROSSWALK UPGRADES PHASE II <br />FEDERAL PROJECT NO: HSIPL 5063(186) <br />EXHIBIT 16-B — SUBCONTRACTING REQUEST <br />RE -BID <br />Local Assistance Procedures Manual Exhibit 16-B <br />CONTRACTORNAME <br />COUNTY <br />I Rom <br />Busmss ADDRESS <br />CONTRACTNUMBER <br />CITY AND STATE <br />ZIPCODE <br />FEDERAL-AmPRO)ECTNUMBER <br />A. SUBCONrRACTOR <br />B. BID ITEM <br />C.PERCMrAGE OF <br />D. SuslzT'Eo <br />ECERTRTED <br />F. DEscarw WORK <br />G.DOLLARAmou NT <br />(Nxru,Bursness Addree% Phone) <br />NUMBER(S) <br />BNITEM <br />ATBronmE <br />DBE <br />WHEN I}$THAN <br />BASEDONTHEBN <br />SUBCONTRACTED <br />100% OF WORK IS <br />AMOUNT <br />SUBCONTRACTED <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />❑ ❑ <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 />• 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 <br />This section is to be completed by the resident engineer. <br />1. Total of bid items <br />2. Conctracmr must perform with own fortes (line 1 %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 Oine 1 minus 5) <br />S <br />5 <br />S <br />5 <br />Approved <br />RESIDENT ENGhNEER'SSIGNATURE. DATE „ <br />Copy Olslnbution: OnginalContractor Copy- Resident Engineer Copy-OBEO. smallbushassadvocatoOdootcaeov or, tax to(916) 324-1949 <br />Page I of 2 <br />.January 2018 <br />P-36 of P-42 RE -BID <br />