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<br /> . • Cam./I~TE,/I'I: BII~I3EI~'S 1~A.I~E: <br /> F.T. ZIEBARTH COMPANY <br /> C~I~ITI~AACT l~t~: AI~I~IZESS: <br /> 05-3195 920 EAST WALNUT AVE FULLERTON CA 92831 <br /> BII~ AI~~~IJNT: <br /> E GOB FR~It~ COI~3'I"Itr-SC'I' AT'VI~€J~dT ®F: <br /> I3II3 ~I~E1~dIl`~G I~AT~: 04/22/10 ~ ~~9150 <br /> ITEM OF VdORK AND DESCRIPTION NAME OF WBE 'r* DOLLAR <br /> CONTRACT OF \uORK OR SERVICES TO BE (Name of V~BEs, Certificate Number and AMOUNT <br /> ITEM NO. SUBCONTRACTED OR MATERIALS Telephone Number) <br /> TO BE PROVIDED DBE <br /> J c--, , <br /> • Total Claimed <br /> Participation $ <br /> * If 100% of item is not to be performed or fumished by WBE, describe exact portion, including planned location of work to be <br /> _performed, of item to beperformed or furnished by WBE <br /> Credit for a DBE supplier, vvho is not a manufacturer is limited to 60% of the amount paid to the supplier. (See Section <br /> ____-_Disadvantaged Business" (WBE~of the special provisions) <br /> II~POIZTAI~IT: 1\lames of CBE subcontractors and their respective item(s) of Work listed <br /> above should be consistent with .the name and items of work in the "I~1St of Subcontractors" <br /> submitted with your bid pursuant to the Subcontractors I~istin I.a~~e <br /> 04/22/10 (714) 992-5151 f <br /> Si re of Bidder Date (Area Code) Tel. No. <br /> R,P. ZIEBARTH, PRESIDENT <br /> Person to Contact (Please type or print) <br /> Distribution for NHS Projects: (])Original-Caltrans DLAE for NHS Projects, (2) Copy-Local Agency project file <br /> Distribution for non-NHS Projects: (I) Original Local Agency project file <br /> DEPT. OF TRANSPORTATION (FED DBE) MODIFIED UC-OE-19 (REV 09-18-95) <br /> • <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP.IB of <br /> <br />