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<br />• <br />Local Agency Bidder DBE Information (Construction Contracts) <br /> <br />• <br />AGENCY: G~ T~ d~ SMITPt -1~f~(A LOCATION: <br /> <br />PROJECT DESCRIPTION: -TR~'~l L ~~j~,AL_ l S" <br />OTAL CONTRACT AMOUNT: $_ ~ ~~~ ~ ~ G) ~° C"~ <br />BID DATE: ~Z'~i.~" ( ~ <br />IDDER's NAME: LINCOW PACIFlC BUILDERS, INC PROJECT NO 08-5022: TRAFFIC SIGNAL INSTALLATIN ON <br />HARBOR BLVD & KENT AVE <br />['AL.LA'[' 10 <br />ONTRACT <br />ITEM NO. ITEM OF WORK AND DESCRIPTION <br />OR SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED BE Cert. No. <br />AND EXPIRATION <br />ATE NAME OF DBEs <br />(Must be certified on [he date bids <br />re opened -include DBE address <br />nd hone number) OLLAR AMOUNT <br />DBE <br /> L ~ L 6 r7C1.4a <br /> S <br /> <br /> <br /> 2(0 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />or Local Agency to Complete: <br /> <br />cal Agency Contract Number: <br />ederal Aid Project Number: <br /> <br /> <br />Federal Shaze: $5,456 <br />Total Claimed <br />Participation <br />~ ' TSB OQIJ • <br /> <br /> <br />'ice <br />(~ J• <br />ontract Award Date: <br />ocal Agency certifies that the DBE certification(s) has been verified and all <br />information is complete and accurate. <br />w <br /> <br />Print Name Signature Date Signature f Bidder <br />b2 ~~• lD ((02(0 <br />Qto ~-?"13 8 <br />ca] Agency Representative <br />(Area Code) Tele hone Number: Date <br /> <br />1 (Area Code) Tel. No. <br /> <br />~ <br />J <br /> LaNco~1~ -HA- <br />or Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer Person to Contact (Please Type or Print) <br /> <br /> <br />Local Agency Bidder DBE Information (Rev 3/OS? <br />Distribution: (I) Copy -Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within I S days of contract execution. Failure to send <br />a copy to the DLAE within I S 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 />TO BE INCLUDED IN BID PACKAGE <br />BP 24 of 34 <br />