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Loral Assistance Procedures Manmd Gchibit 10.02 Consultant Contract DBL Commitment INS11RUCTIONS-CONSULTANT CONTRACT DUE COMMITMENT CONSULTANT SECTION L Local Agency - Enter the name of the local or regional agency that Is iitnding the contract. 2, Contract DOE Goal - Enter the contract DBE goal percentage as it appears on the project advertisement, 3, Project Description - Enter the project description as it appears on the project advertisement (Bridge Rehab, Seismic Rehab, Overlay, widening, ctc). 4. Project Location - P.nter the project location as it appears on the project, advertisement, 8. Consultant's Name -Enter the consultant's firm name. b. Prime Certified 013E , Check box if prime contractor is a certified DOE. 7. Total Contract A'svord Amount -Enter the total contract award dollar amount for the prime consultant, $. Total Dollar Amount for ALL Subconsultauts Bitter the total dollar amount for all subcontracted consultants, SUM - (DBEs +all Non -DBEs). Do not include the prime consultant Information ht this count. 9. Total number of ALL subconsdltants- Lntee the total number of all subcontracted consultants, SUM = (DBEs +All Non-DOEs). Do not %rcolude the primeconsultant Inforntatlotrin this cortnt. 10. Description of Work, Services, or Materials Supplied - Enter description of work, services, or materials to be provided. Indicate all wort` to be performed by DBEs including work performed by the prime consultant's own forces; if the prune is a OOE. I f 100% of the item is not to be perforated or furnished by the DOB, describe the exact portion to be performed or furnished by the DOE. See LAPM Chapter 0 to determine' how to count the participation of DOE firms, 11. DRE Certification Number -.Enter the DOE's Certification Identification Number. All DBEs must be certified on the date bids are opened, 12. DBE Contact Information - Enter the name„ address, and, phone number of all DOE Subcontracted consultants. Also, enter the prune consultant's name and phone number, if the prime is a DOE. 13. DRE DollarAterount-Enterthesubcontracteddollaramountofthework.tobeperformedorservicetobe provided, include the prime consultant if the prime is a DBE. See LAPM Chapter 0 for how to count fill/partial participation. 14, Total Claimed DBE Participation - $; Banter the total dollar amounts entered in the "OBE Dollar Amount" coltram. 'You Enter the total DBE participation claimed ('"Total Participation Dollars Claimed" divided by item "Total Contract Award Amount"). If the total % cin irued is less than item `"Coatmct DOB; Goal," an adequately documented flood Faith Effort (GFP) is required (see Exhibit IS-14 DOE Information- Good Faith Efforts of due LAPM)„ 'IS. Preparer's Signature - The person completing the DOE commitment form on behalf of the consultant's firm must sign their name. 16. Date - Enter the date the DOE commitment farm is sighed by the Qonsultant's prepares. 17. Preparers Name Enter the name ofduc'person preparing and slgningthe, consutant's DOE commitment form'. 18, Phone, Enter the area code and phone number of the parson signing the consultant's DOE commitment form. 19. Preparer's Title - Enter the posithpo/tillo o'Jfthe person signing the consultant's DOE commitment farm. LOCAL AGENCY SECTION 20, Local Agency Contract Number -Enter the Local Agency contract number or Identifier. 21, Federal -Aid Project Number - Enter the Redefal•Aid Project Number. 22. ContractExecution Date - Enter the date the contract witsexecuted, 23. Local Agency Representa tive's Signature- The person completing this section of the farm for the Local Agency must sign their name to certify that the information in this and the Consultant Section of this rural is complete and accurate. 24. Date -Enter the date the DBE commitment form is signed by the Local Agency Representative, 25. Local Agency Representative's Name - Enter the name of the Local Agency Representative certifying the. consultant's DOE commitment form. 26. Phone - Enter the area code and phone number of the person signing the consultant's DOE commitment form. 27. Local Agency Representative Title - Enter the position/title ofthe Local Agency Representative certifying the consultant's DBE commitment form. Page 2 of 2 July 23, 2015