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• <br />Local Agency BIDDER-DBE (Construction Contracts)-lnformation <br />T'he successful BIDDER must execute and return the LOCAL .AGENCY' BIDDER -DBE INFURMA"TION form, even if no DBE <br />participation will be reported. <br />AGENCY Clty Of Santa A17a __ LOCATION: Bella Vista, Casa Bonita, Central City and Pico-Lowell <br />PROJECT DESCRIPTION: _Neighhorhood hnprovements <br />CON"TRAC'T' NUMBER:_ __ __ <br />FEDERAL-AID PRO.IECT NUMBER: CDBG _ __ <br />TO'IALCONTRAC"f AMOUNT:~_2,35$662,5~ _ - <br />FEDGRALSHARE (For local agency to complete) : $_ <br />BInDArE 02118 /2010 -- <br />BiDDER'sNAME: - R _J . No-b1e Company - _ __--- - <br />AUVERT'ISED DBG CON"TRACT AVAII.ABtI ITV .anvtcnRV P~r~...,~~Ra~ <br /> <br />ON"IR,AC"I <br />I'I'f:M NO. - - <br />T'EM OF WORK ANU DESCRIPTION <br />)R SERVICES TO BF, <br />'IIBCON"fRAC"TED OK MATEKLALS <br />10 BE PROVIDED' - -"- " -~--...-c_. <br />I)BE Cert. No. <br />ND EXPIRATION <br />)A"fE <br />AME OF DBFs ' <br />Must be certified on the date bids <br />re opened -include DBE address <br />and phone number) <br />UOI_LAR AMO[1NT' <br />DBE ' <br />portion <br />of 4~2 _ PROVIDE ASPHALT <br />_ OIL __ _ T_$~88Q3 <br />ni ~ 186 Li uid_t <br />475.00 <br />----_P. <br /> _Av = 88,350.00 <br /> <br />----- <br />----- - - <br />gn~t,nt~n 699_ _ <br />~ t 0 <br />00 <br /> . <br />_ <br /> <br /> <br /> <br />__ _ , <br /> <br /> <br />IMPOK CAN'C: Identify all DBE (inns being participating in the project, regardless of <br /> <br />ter. Names of the First Tier DBE Subcontractors and their respective item(s) of work <br />i <br />Total Claimers <br /> <br />Parti <br />i <br />i <br />53 010.00 <br />$ ~ <br />stcd abme should be consistent, where applicable, with the names and items of work m c <br />pat <br />on - <br />he "List of Subcontractors" submitted with your bid. Provide copies of the DBEs' <br />cotes, and if applicable, a copy of joint venture agreements. pursuant to the <br />'ubcontractors Listing law and the Special Provisions. <br />2.24 % <br />1. F.:nter DBE prime and subcontractors certification number. Prime contractors shall <br />indicate all work to be performed by UBFs includin <br />wot'k <br />erfor <br />d b <br />it <br />X <br />g <br />p <br />me <br />y <br />s own _ <br />forces. M' ael J. Carver, President <br />If tO0`% of item is not to be performed or furnished by DBE, describe exact portion of <br />item to he performed or furnished by DBE. Signature of BIDDER <br /> <br />3. Sec Section "Disadvantaged Business Enterprise (DBE) <br />" of the S <br />ecial Provisions 02/18/2010 714-637-1550 <br />- <br />, <br />p <br />(construction contracts); to determine how to count the participation of DBE firms. ---_ <br /> Date fArea Code) Tel. No. <br />t,ocar ,vgency tSIllUtN - UBIs Inlbnnation (Rev 5101/06) <br />Distribution: (I) Copy -Fax immediately to the Caltrans District IACaI Assistance Engineer (DEAF) upon award. <br />(2) Copy -Include in award package to Caltrans District L.ocai Assistance <br />(3) Original -Local agency files <br />ns <br />r ton <br />TO BE INCLUDED IN BID PACKAGE <br />BP 22 of 30 <br />