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Local Agency der UDBE Commitment (Conduction Contracts) <br />• <br />• <br />GENCY: C \ ~ti rJ ~i ~ RtJ~ h ANA LOCATION: PROJECT NO 08-5019: TRAFFIC SIGNAL INSTALLATION ON <br />n IIAZARD E/O GATES ST <br />ROJECTDESCRIPTION: T(~Asr~l., J i.e„~u p. <br />OTAL CONTRACT AMOUlNT: $ t~ ~ `~ Z , O ~ <br />ID DATE: 3 / 3 ~ \O <br />IDDER'SNAME: T,Q{LWO ZaaNGG / <br />ONTRACT UDBE GOAL: 3 .7! _ \ ~/ O <br />ONTRACT <br />ITEM NO. TEM OF WORK AND DESCRIPTION <br />R SERVICES TO BE <br />SUBCONTRACTED 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 />3 0~ s C'o-,~ ll °~ a u E\e ~'R~~S 31 3 ,4 <br /> 2 <br /> <br /> <br /> <br /> °l \30. p~ <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 />ederal Share: 9 282 <br />Total Claimed <br />Participation <br />$ 13D~ hp_ <br /> <br /> <br />~ ` <br />ontract Award Date: <br />"" <br />ca] Agency certifies that al] information is complete and accurate. <br /> <br />rint Name Signature Date <br />Local Agency Representative Signature of B' er .-~ <br />~ <br />3 0 / \ - 'Z'Z ~j- C7~(03, <br /> <br />Area Code) Tele hone Number: Dat (Area Code) Tel. No. <br />or Caltrans Review: ~C,_~~ ati ~ ku ` R ~ ~ <br /> <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />l:.. w:L..~:.,_. Person to Contact (Pleas Type or Print) <br /> <br />Local Agency Bidder -UDBE Commitment (Rev 3/09) <br />.,~~~~~~~~,.,~~. t~/ wpy - rax un~ncmatery to me ~aitrans utsmct Locat Asststance Engtneer (DEAF) upon award. <br />(2) Copy -Include in award package to Caltrans District Local Assistance <br />(3) Original -Local agency files <br />• <br />TO BE INCLUDED IN BID PACKAGE <br />BP 21 of 32 <br />