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L~~1-~~ A~E~~'~ ~I~3I~E~-1'i~~~ ~~T~,{3A'~I~I`~T <br /> CO./RT~JP~dI: BIDI3ER'~ 1vAl~$E: <br /> F.T. ZIEB~ARTI-I C~7MPANY <br /> _ <br /> O~Iti1TP.~CT I~10: ADDRESS: <br /> 05-3195 920 EAST WALNUT AVE FULLER`,":~~_^2831 <br /> BID AIVi10TJl~tT: <br /> $ _ <br /> li~iB~ G®AI, F'ROI~4 COI~tTRAC'I' A~'i~°OUN'I' ?.:)ff+': <br /> BII9 ®PEi~TIi~tG I?AT~: 04/22/10 ~ 5,300 <br /> ITEM OF 1~IORK AND DESCRIPTION NAME OF MBE DC?I,LAR <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 i~BE <br /> .._.._Y..._._.._,~. _4._._~ i <br /> i <br /> Total Claimed j <br /> Participation $ <br /> * If ] 00% of item is not to be performed or furnished by MBE, describe exact portion, including planned loci con of wcr!,: to be <br /> _ --performed, of item to be erformed 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" (b4BE) of the special provisions) _ <br /> II~ZP.ORTAl°dT: I~Tames of TVIBE subcontractors and their respective item(s) of work. listed <br /> above should be consistent with the name and items of work in the "List of Snbcontra..tors" <br /> submitted with your bid pursuant to the Subcontractors I..istin~ Law. <br /> _II <br /> 04/22/10 (714) 992-5151 ~ <br /> i <br /> <br /> . S ature of Bidder Date (Area Code) Tel. No. r <br /> R.P. ZIEBARTH PRESIDENT ~I <br /> F.T. ZIEBARTH C6MPANY <br /> i <br /> Person to Contact (Please type or print) a <br /> Distribution for NHS Projects: (1) Original-Caltrans DLAE for NHS Projects, (2) Copy-Local Agencyproject file <br /> Distribution for non-NHS Projects: (1) 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 <br /> <br />