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.e , <br /> <br /> • CO./~TE.IP~?i: ~I~I~E'S l'~~.ED <br /> F.T. ZIEBARTH COMPANY <br /> C01~1TE.AGT 1~0: ~D~~E~S: <br /> 05-3195 920 EAST WALNUT AVE FULLERTON CA 92R~1 <br /> BII3 A1~OZTI~1To <br /> Ii~BE GOAL ~'ItOl~~i COi <br /> 1 C'I' A1t~0U~+1'I' OF: <br /> B~I~ OPET~dIIdG I?ATE: 04/22/10 $ 5,300 <br /> ITEM OF 1~VORK AND DESCRIPTION NAME OF MBE DOLLAR <br /> CONTRACT OF WORK OR SERVICES TO BE (Name of MBEs, Certification Number AMOUNT <br /> ITEM NO. SUBCONTRACTED OR MATERIALS and Telephone Number) <br /> TO BE PROVIDED DBE <br /> 9v~j 3s~ - ids ' ~ ~ ~~G l; <br /> , if /`'tis % <br /> li~"~? ~ <br /> i~,h ilf~~ S <br /> 7 V~ s', 7 ce~~ i~G~s <br /> Cam= (5 ~ ~ ~,~'J - ~f;~.~~' c ~ y ~j' <br /> • Total Claimed <br /> Pa>-ticipation $ <br /> If 100% of item is not to be performed or furnished by MBE, describe exact portion, including planned location of work to be <br /> __-___performed,_of item to be performed or furnished by MBE___ _ _ _ _ <br /> Credit for a MBE supplier, who is not a manufacturer is limited to 60% of the amount paid to the supplier. (See Section <br /> "Disadvantaged Business" (MBE) of the special rovisions <br /> P - <br /> ITiZPOIiT~TiTT: I'~lames of TVI~E subcontractors and their respective item(s) of worl~ listed <br /> above should be consistent with the mine and items of work in the "List of Subcontractors" <br /> submitted with your bid pursuant to the Subcontractors Listing Law. <br /> - 1 <br /> ~ 04/22/10 (714) 992-5151 <br /> ature of Bidder Date (Area Code) Tel. No. <br /> R.P. ZIEBARTH PRESIDE[VT <br /> F.T. ZIEBARTH COMPANY <br /> Person to Contact (Please type or print) <br /> Distribution for NHS Projects: (1) Original-Caltrans DLAE for NHS Projects, (2) Copy-Local Agency project file <br /> Distribution for non-NHS Projects: (1) Original Local Agency project file <br /> DEPT. OF TRANSPORTATI®N (FED DBE) MODIFIED DC-OE-19 (REV 09-18-95) <br /> <br /> • <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP ~ -f-of Z <br /> <br />