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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 />cONTRACrORNAME HYM Engineering, Inc. <br />COUNTY Orange <br />ROUTE <br />BUSINESS ADDRESS 1559 W. Commonwealth Ave. <br />CONTRACrNUMBER 18-6903 <br />CITY AND STATE Fullerton, CA <br />fl <br />ZIPCODE 92033 <br />28 <br />FEDERAL -AID PROJECT NUMBER <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. DOLLARAMOUNT <br />(Name, Business Adthem Phorte) <br />NUMB13R(3) <br />BID ITEM <br />ATB[DTIME <br />USE <br />WHEN LESS THAN <br />BASED ON THE BID <br />SUBCONTRACTED <br />100% OF WORK IS <br />AMOUNT <br />SUBCONTRACTED <br />;sr <br />1 ��/ Ig <br />'/ <br />Yes No <br />Yes No <br />-6kq r Z.07 <br />/ p <br />M El <br />/ C/M 7# <br />Yes No <br />Yes No <br />.� o.L. t <br />❑ ❑ <br />❑ ❑ <br />�iQ/Sp C'OM A n," <br />O-11 N, OX <br />Yes No <br />Yes <br />4WI <br />6914A <br />Lai <br />[No <br />l <br />Qg— 7g4 ^-Dji <br />l/a /Y,l3 <br />Yes No <br />Yes No <br />El 1:1 <br />El El <br />)19r d4 <br />Yes No <br />Yes No <br />y� <br />❑ ❑ <br />❑ ❑ <br />Yes No <br />Yes No <br />❑ ❑ <br />1 ❑ ❑ <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. Contractor must perform with own forces (line 1 X contract mq. %) <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 sine 3 plus 4) <br />6. Balance of work contractor to perform (line 1 minus 5) <br />$ <br />RESIDENT ENGWERRrS SIGNATURE DATE <br />copy umtnouuon: unbnnai-�onrracror copy- xesident Engineer Copy- UBEU-sma116usinessadvocaCe¢7Aoot ca.eov or fax to(916) 324.1949 <br />Page 1 of 2 <br />January 2018 <br />P-34 of P-39 <br />