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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6897 <br />FLOWER STREET BIKEWAY <br />FEDERAL PROJECT NO: HSIPL 5063 (187) <br />EXHIBIT 16-B - SUBCONTRACTING REQUEST <br />Local Assistance Procedures Manual <br />Exhibit 16-B <br />CONIRACIURNAME <br />COUNTY <br />ROUTE <br />Fleenor Belco Electric, Inc. <br />San Bernardino <br />BUStNFSS AD DRESS <br />CONTRACTNumllm <br />14320 Albers Way <br />CITY AND STATE <br />2>PCoor. <br />y�St1PI"5W6'3'(A7jNbMnLR <br />Chino, CA <br />91710 <br />A. SUBCONTRACTOR <br />B. ButTrEM <br />C. PERCENTAGEOF <br />I). SUB I.I.S-TED <br />ECERTMED <br />F. DESCRIBE WORK <br />G. DOLLAR AMOUNT <br />(Name, Boom Add revs. Phone) <br />NUMBERS) <br />BIDITEM <br />ATBIDTIML <br />DBE <br />WHEN LESS THAN <br />BASP:DON TUN BID <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 FH WA-12T3 of the Special Provisions has been inserted in the subcontracts and should be <br />incorporated in any to Her subcontract. Written contracts have been executed for the above noted subcontracted <br />work. IN <br />John Wong I --,- MaY 19.2020 <br />This section is to be co lete by <br />1, 'rural of bid items <br />2. Conetractor must perform w <br />(tine 1 X contract req. %) <br />3. Bid items previously subcontracted (taken from previously approved 16-6) <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 />t <br />RESIDENT FNGINFFR'S SIGNATURE. DATE, <br />Copy Distribution:Original-Contractor Copy- Resident Fngineer Copy-OBEO-smaairusLtessadvassleSeduyl,cn or I. to (916) 324-M9 <br />Page 1 of 2 January 2018 <br />S•x •aJJ <br />