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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 />CONTRACrORNAME <br />COUNTY <br />ROUTE <br />Fleenor Belco Electric, Inc. <br />San Bernardino <br />BUSWESSADDRESS <br />CONTRACTNUMBER <br />14320 Albers Way <br />CITY AND STATE <br />ZIPCODE <br />FEDERAL -AID PRO Cr NUMBER <br />Chino, CA <br />91710 <br />HSIPL-5063(1i87) <br />A. SUBCONTRAC OR <br />B. BID ITEM <br />C. PERCENTAGE OF <br />D. SHE LISTED <br />E. CERTIFIED <br />F. DESCRIBE WORK <br />G. DOLLAR AMOUNT <br />(Name, Business Address, Phone) <br />NUMBER(S) <br />BIDITEM <br />AT BID TIME <br />DBE <br />WHEN LF%THAN <br />BASEDONTHEBID <br />SUBCONTRACTED <br />100% OF WORK LS <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 />❑ ❑ <br />❑ ❑ <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 lows{ -tier subcontract. Written contracts have been executed for the above noted subcontracted <br />work. n <br />Contractor Signature , John Wone I Date Mav 19.2020 <br />This section is to be colete by thUesdentcn&eer. <br />1. Total of bid items2. Contractor must perform with (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 I minus 7 <br />5 <br />Approved <br />RESIDENT ENamEER'9 SIGNATURE D.A I F <br />Copy Distribution: Unginal-Contractor Copy- Resident Engineer Copy- UBEO- smallbusinessadvocateradoot ca. oovv or fax to (916) 324-1949 <br />Page 1 of 2 January 2018 <br />P-46 of P-52 <br />