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<br />• <br />Local Agency Bidder DBE Information (Construction Contracts) <br />r~ <br />• <br />AGENCY: ~TY ~ SANT~ ANA <br /> <br />PROJECT DESCRIPTION: ~TRl~f=tG SICaI~IA <br />OTAL CONTRACT AMOUNT: $ 1 ~~ ~ L9 ~ ~' <br />BID DATE: ~2'2S • ~~ <br />BIDDER'S NAME: LINCOLN PACIFIQ~j(J~(,p LOCATION: <br /> <br />L <br />~' ~ <br /> <br />E}~r~ PROJECT NO 08-5017: TRAFFIC SIGNAL INSTALLATION ON <br />WILLITS ST & SULLIVAN ST <br />aNSTAI.t_ATto~ <br />ONTRACT <br />ITEM NO. ITEM OF WORK AND DESCRIPTION <br />R SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED BE Cert. No. <br />ND EXPIRATION <br />ATE AME OF DBEs <br />(Must be certified on the date bids <br />e opened -include DBE address <br />nd hone number) DOLLAR AMOUNT <br />BE <br /> L 1 35S i gut, ooo. <br /> n ST <br /> <br /> b <br /> b ~ bb ? <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />or Local Agency to Complete: <br />Total Claimed <br />~ ~ 35, o 00 . <br />ocal Agency Contract Number: <br />ederal Aid Project Number: <br /> <br />ederal Share: _ $7,258 Participation <br /> <br />C~ <br />ontract Awazd Date: <br />` <br />ocal Agency certifies that the DBE certification(s) has been verified and all <br />information is complete and accurate. ~L--- <br /> <br />riot Name Signature <br />Date Signnature f Bidder ~ ~ ~~ <br />~2'~• ~ 0 q b a- 773 g <br />ocal Agency Representative <br />(Area Code) Tele hone Number: Date (Area Code) Tel. No. <br />~~ ~ <br />~ <br /> LO <br />~A <br />or Caltrans Review: <br />Print Name Signature <br />Caltrans District Local Assistance Engineer <br />Date Person to Contact (Please Type or Print) <br /> <br /> <br />Local Agency Bidder DBE Information (Re~~ 3/09; <br />U~stnbution: (1) Copy -Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within I S days of contract execution. Failure <br />to send a copy to the DLAE within 15 days of contract execution may result in the de-obligation of funds for this project. <br />(2) Copy -Include in awazd package to Caltrans District Local Assistance <br />(3) Original -Local agency files <br />TO BE INCLUDED IN BID PACKAGE <br />BP 20 of 34 <br />