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Local Assistance Procedures Manual <br />EXHIBIT 1 <br />Exhibit 10-02 <br />Consultant Contract DBE Commitment <br />1. Local Agency: <br />3. Project Description: <br />4. Project Location: <br />5. Consultant's Name: <br />EXHIBIT 10-02 CONSULTANT CONTRACT DBE COMMITMENT <br />8. Total Dollar Amount for ALL Subconsultants: <br />2. Contract DBE Goal: <br />6. Prime Certified DBE: ❑ 7. Total Contract Award Amount: <br />9. Total Number of ALL Subconsultants: <br />10. Description of Work, Service, or Materials <br />Supplied <br />11. DBE <br />Certification <br />Number <br />12. DBE Contact Information <br />13. DBE <br />Dollar <br />Amount <br />Local Agency to Complete this Section <br />14. TOTAL CLAIMED DBE PARTICIPATION <br />$ <br />20. Local Agency Contract <br />KI-1 -'' <br />21. Federal -Aid Project Number: <br />22. Contract Execution <br />nntP- <br />Local Agency certifies that all DBE certifications are valid and information on <br />this form is complete and accurate. <br />23. Local Agency Representative's Signature 24. Date <br />25. Local Agency Representative's Name 26. Phone <br />27. Local Agency Representative's Title <br />% <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />regardless of tier. Written confirmation of each listed DBE is <br />required. <br />15. Preparer's Signature 16. Date <br />17. Preparer's Name 18. Phone <br />19. Preparer's Title <br />DISTRIBUTION: 1. Original — Local Agency <br />2. Copy — Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract <br />execution may result in de -obligation of federal funds on contract. <br />ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654- <br />3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. <br />City Council 13 — 49 8/2/2022 Page 1 of <br />July 23, 2015 <br />