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Local Assistance Procedures Manual <br />Exhibit 10-02 <br />Consultant Contract DBE. Commitment <br />EXIT IBPI' 10-02 CONSULTANT CONTRACI' DBE COMMITMENT <br />1. Local Agency: City or Santa Ana <br />3. Project Description: Willits Street Safe Routes to School <br />4. Project Location: Santa Ana. CA <br />2. Contract DBE Goal: 0.0% <br />5. Consultant's Name: Walk'n Rollers 6. Prime Certified DBE: ❑ 7. Total Contract Award Amount: 180,000 <br />8. Total Dollar Amount for ALL Subconsullants: $31,800 9. Total Number of ALL Suhconsultants: 2 <br />10. Description of Work, Service, or Materials <br />Supplied <br />11. DBE <br />Certification <br />Number <br />12. DBE Contact Infarmation <br />13. DBE <br />Dollar <br />Amount <br />Local Agency to Complete this Section <br />$ <br />20. Local Agency Contract <br />21. Federal -Aid Project Number. <br />14, TOTAL CLAIMED DBE PARTICIPATION <br />22. Contract Execution <br />0.0 % <br />Dam <br />IMPORTANT: Identify all BL4nns being claimed for credit, <br />regardless of tier. Writte confir atmn of each listed DBE is <br />Local Agency certifies that all DBE certifications are valid and information on <br />this form is complete and accurate, <br />requir <br />11-9-2021 <br />23. Local Agency Representative's Signature 24. Date <br />pacers Sig a re . Date <br />James Shanman 310-204-4346 <br />25. Local Agency Representative's Name 26. Phone <br />17. Preparers Name 18. Phone <br />Executive Director <br />27. Local Agency Representative's Title <br />19. Preparers 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 cl -0bligation of federal funds on contract. <br />ADA Notice: For Individuals with sensory disabilities, this document is available in alternate formals. For information call (916) 6546a10 or TDD (916) 654 <br />3880 or write Records and Forms Management 1120 N Street, MS-89. Sacrament, CA 95814. <br />Page I oft <br />July 23, 2015 <br />