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Local Agency der UDBE Commitment (Con~ction Contracts) <br />r~ <br />• <br />GENCY:S t~ ~S~ S AN~/~ ~ ~J ~ LOCATION: PROJECT NO 08-5018: TRAFFIC SIGNAL INSTALLATION ON <br />IIAZARD AVE & ROSITA ST <br />ROJECT DESCRIPTION: T~ A~ ~ ~ v S ~ G, IJ w\ <br />OTAL CONTRACT AMOUNT: $ \ "j ~, S ~ ~o ,~I b <br />ID DATE: 3I3 ~ ~ O <br />IDDER'S NAME: T~ 0. u O . TN c. <br />ONTRACT UDBE GOAL: 3 . ~~ <br />ONTRACT <br />ITEM NO. TEM OF WORK AND DESCRIPTION <br />R SERVICES TO BE <br />UBCONTRACTED OR MATERIALS <br />O BE PROVIDED ert. No. of UDBE <br />ND EXPIRATION <br />ATE AME OF UDBEs <br />Must be certified on the date bids <br />re opened -include UDBE address <br />nd hone number OLLAR AMOUNT <br />DBE <br /> eo\~y Co oll ~ ~Ie ~ 34 ~~ <br /> <br /> Ub-'1 - S b <br /> <br /> <br /> 2,0 00, fob <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />For Local Agency to Complete: <br /> <br />Local Agency Contract Number: <br />ederal Aid Project Number: <br />ederal Share: 9 465 <br />Total Claimed <br />Participation <br />$ 2 p ~ a~. <br />-~---~o <br /> <br />1 ~ % <br />ontract Award Date: <br />!- <br />cal Agency certifies that all information is complete and accurate. <br />~~ <br /> <br />rint Name Signature Date <br /> <br />cal Agency Representative Signature of B}A er <br />~ ~ <br />i <br />3 ` CO -'z <br /> <br />Area Code) Tele hone Number: Date' (Area Code) Tel. No. <br />or Caltrans Review: Ktc,~nwn ~, kk; ~~A <br /> <br />Print Name Signature Date <br />Caltrans Distract LOCaI Assistance Engineer Person to Contact (Ple se Type or Print) <br /> <br />Local Agency Bidder -UDBE Commitment (Rev 3/09) <br />.~mu~uuuuu. tt~ ~.uNy -ran tunucumtc~y w utc l.altrari5 U15177CI LOCaI ASS1SLanee trnglneer (LLAt',) Upon award. <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 19 of 32 <br />