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~G~~~~ ~IDI~ER-IY~~~ ~'V~A7CI~I~ <br /> Ct}JRTE./Pl'~: BIDDER'S I~A.I~E <br /> <br /> - F.T. ZIEBARTH C:(~:~1PANY <br /> C~lelTla-SC'I' I~t~: - ADDRESS: - <br /> 05-3195 920 EAST WALNUT A~ F[TI~LER'I~.~&_32$.~1-_ <br /> ~iD AIYIOZJT~IT: <br /> IYtB~ .GOAL F'R01~4 +~'~Ol~tTRAC~' AIYILr UNT d'E~' - <br /> 13~D ®FEhTIi~dG I~AT~: 04/22/10 ~ 5$,300 <br /> ITEM OF WORK AND DESCRIPTION NAME OF N1ziE DOLLAR <br /> CONTRACT OF WORK OR SERVICES TO$E (Name of MBEs, Certification Number AMOLTJT <br /> ITEM NO. SUBCONTRACTED OR MATERIALS and Telephone P lumber} **-r <br /> TO BE PROVIDED DBE <br /> ~ <br /> ~ ~z ~7-5~J 7 C,c--~' v~-3~ <br /> , <br /> Total Claimed <br /> Participation <br /> * If 100% of item is not to-be performed or furnished by MBE, desc>•ibe 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 provisions) _ _ <br /> II~ZPORTAlVT: I~Tatnes of 1'VIBE subcontractors and their resg~cti~e item(s) of work listed <br /> above should be consiste>at with the name and items of work in the "List of Subcontractors" <br /> submitted with your bid pursuan# to the Subcontractors Listing ILa~,~. <br /> 04/22/10 (714) 992-5151 <br /> Si ure of Bidder Date (Area Code) Tel. No. <br /> R.P. ZIEBARTH PRESIDENT <br /> F.T. ZIEBARTH C6MPANY <br /> Person to Contact (Please type or print) <br /> Distribution for NHS Projects:. (I) Original-Caltrans DLAE for NHS Projects, (?)Copy-Coca? Agencyproject file- <br /> Distribution for non-NHS Projects: (1) Original Local Agency project file <br /> IDEPT. OF TRAIdSPORTATI014 (FED DSE) M©DIFIED DC-OE-19 (REV 09-t b'-95) <br /> TO BE ~NCLU~ED IN BID PACKAGE <br /> <br />