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I~~~AIJ A~~1~CY BII3I~~IZ-IVIB~ I1~t~~I~~~IA'7iI€~~ <br /> Ca.iRT~.i~r~I: BIDDER'S NA1~E: <br /> F.T. ZIEBARTH COMPANY <br /> CONTRACT NO: ADDRESS: <br /> 05-3195 920 EAST WALNUT AVE _ <br /> FCTr LF'R'r+nly A 92R~ l <br /> BID AlY(OUNT: <br /> $ <br /> MBE GOAL FRO1~~I CONTRACT' AMOUNT' OF: <br /> BID OFEi~TING DAT : 04/22/10 ~ 5,300 <br /> ITEM OF WORK AND DESCRIPTION NAME OF MBE DOLLAR <br /> CONTRACT OF WORK OR SERVICES TO BE (Name of MBEs, Certification Nlumber AMOUNT <br /> ITEM NO. SUBCONTRACTED OR MATERIALS and Telephone Number) <br /> TO BE PROVIDED DBE _ <br /> ~,i ELE~i <br /> /'i~~ L. / TLC-RF}7,U <br /> .S'~'(,>'C' iltti~ ~?=<<-- - ~ c~~ ~76~1 2351 <br /> ~ ,Q ~ _S ice: <br /> S 3/- (~1d'~ C~~'i <br /> ~ ~xs 12.x% <br /> Total Claimed <br /> PaI-ticipation $ <br /> * If 100% of item is not to be performed or fumished by MBE, describe exact portion, including planned location of work to be <br /> <br /> _ ___performed,_of item_to be performed or fumished by MBE <br /> *T 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 provisions) <br /> II+~ZPORTANT: Dames of TvIBE subcontractors and their respective itean(s) of work listed <br /> above should be consistent with the name and items of work in the "List of Subcontractors" <br /> submitted with your bid pursuant to the Subcontractors Listi;a Law. <br /> 04/22/10 (714) 992-5151 <br /> ature of Bidder Date (Area Code) Tel. No. <br /> R.P. ZIEBARTH PRESIDENT <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 Agencyprojecl file <br /> Distribution for non-NHS Projects: (l) Original Local Agency project file <br /> DEPT. OF TRANSPORTATION (FED DBE) MODIFIED DC-OE-19 (REV 09-18-95) <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP [ ~-of Z 6 <br /> <br />