Laserfiche WebLink
Local Assistance Procedures Manual <br />Exhibit 10-02 <br />Consultant Contract DBE Commitment <br />EXHIBIT 10-02 CONSULTANT CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana <br />2. Contract DBE Goal: 8% <br />3. Project Description: On -Call Engineering Services <br />4. Project Location: City Of Santa Ana <br />5. Consultant's Name: UltraSystems Environmental S. Prime Certified DBE: ❑ <br />7. Total Contract Award Amount: $950,000.00 <br />8. Total Dollar Amount for ALL Subconsultants: 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 />Environmental Consulting Services <br />25485 <br />Betsy A. Lindsay <br />$76,000 <br />Local Agency to Complete this Section <br />$ $76,000 <br />20. Local Agency Contract <br />Nimhcr' <br />14. TOTAL CLAIMED DBE PARTICIPATION <br />21. Federal -Aid Project Number: <br />22. Contract Execution <br />8 <br />Hare <br />Local Agency certifies that all DBE certifications are valid and information on <br />IMPORTANT: Identify ail DBE firs being claimed for credit, <br />this form is complete and accurate. <br />regardless of tier. Written confirmation of each listed DBE is <br />required. <br />s <br />1/9/2023 <br />23. Local Agency Representative's Signature 24. Date <br />15. Prep rer's Signature 16. Date <br />Betsy A. Lindsay 949/788-4900 x, <br />25. Local Agency Representative's Name 26. Phone <br />17. Preparer's Name 18. Phone <br />President/CEO <br />27. Local Agency Representative's Title <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 disablI lies, this document is available In alternate formats. For Information call (916) 654-6410 orTDD (916) 654- <br />3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. <br />Page 1 of 2 <br />July 23,2015 <br />