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Local Assistance Procedures Manual Exhibit 10-O1 <br />Consultant Proposal DBE Commitment <br />EXHIBIT 10-O1 CONSULTANT PROPOSAL DBE COMMITMENT <br />1. Local Agency: 2. Contract DBE Goal: <br />3. Project Description: <br />4. Project Location: <br />5. Consultant's Name: 6. Prime Certified DBE:  <br />7. Description of Work, Service, or Materials <br />Supplied <br />8. DBE <br />Certification <br />Number <br />10. DBE % <br />% <br />Local Agency to Complete this Section <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />17. Local Agency Contract Number: <br />18. Federal-Aid Project Number: <br />19. Proposed Contract Execution Date: <br />20. Consultant’s Ranking after Evaluation: __________________________ <br />Local Agency certifies that all DBE certifications are valid and information on <br />this form is complete and accurate. <br />9. DBE Contact Information <br />11. TOTAL CLAIMED DBE PARTICIPATION <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />regardless of tier. Written confirmation of each listed DBE is <br />required. <br />12. Preparer's Signature 13. Date <br />14. Preparer's Name 15. Phone <br />16. Preparer's Title <br />DISTRIBUTION: Original – Included with consultant’s proposal to local agency. <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 />LPP 18-01 Page 1 of 2 <br />January 2019 <br />EXHIBIT 1 <br />4