Laserfiche WebLink
Local Agency Bidder DBE Information (Construction Contracts) <br />• <br />.7 <br /> <br />GENCY: CiITY D~ 6ANTPr AIJA LOCATION: PROJECT N008-5021: TRAFFIC SIGNAL INSTALLTION ON <br />RAITT ST & GLENWOOD PL <br />PROJECTDESCR[PTION: TR~~1L S1bNOrl.. ItJsTALL.A'fT~t~l <br />OTAL CONTRACT AMOUNT: $ 1 ~ 7 i ~Cj ~ ~ l~ <br />BID DATE: O2~~5' ~ ~ <br />BIDDER'S NAME: tJNCOLN PACIRC BUILDERS ~C <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 />D EXPIRATION <br />ATE AME OF DBEs <br />(Must be certified on the date bids <br />reopened -include DBE address <br />nd hone number) OLLAR AMOUNT <br />BE <br /> (~ GAL o OOU. <br /> a l t 'f two s <br /> L <br /> <br /> 2b ~tb0-7 3 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />or Local Agency to Complete: <br /> <br />l A <br />C <br />N <br />b <br />Total Claimed <br />~ 13 U~ Q ~ . <br />oca <br />gency <br />ontract <br />um <br />er: <br />ederal Aid Project Number: <br />Federal Share: $7.616 Participation <br /> <br /> <br />3 % <br />ontract Award Date: <br />cal Agency certifies that the DBE certification(s) has been verified and all <br />information is complete and accurate. <br />~_ <br /> <br />riot Name Signature Date Signature fBidder ~6aZ~O, p <br />QZ -2'~ ~~ -l b C'~73 6 <br />ocal Agency Representative <br /> <br />(Area Code) Tele hone Number: Date <br />(Area Code) Tel. No. <br />~ <br />_ 1 <br />~ n ~ <br /> I <br />~ <br />~~ <br />`- <br />or Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer Person to Contact <br />(Please Type or Print) <br /> <br />Local Acency Bidder DBE Information (Rev i/09) <br />u~smounon: t i ~ copy - rax or scan a copy to the Caltrans llistnct Local Assistance Engineer (DEAF} within I S days of contract execution. Failure to <br />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 award package to Caltrans District Local Assistance <br />(3) Original -Local agency files <br />BP 22 of 34 <br />TO BE INCLUDED IN BID PACKAGE <br />