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• <br />Exhibit 15 -G1 Local Agency Bidder UDBE Commitment (Construction Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS <br />AGENCY:_ t { tT_,j,(�4V)+n PQ LOCATION: al <br />PROJECT DESCRIPTION: PROJECT NO. 11-6733: LYON STREET REHABILI ATION FROM EDINGER AVE TO <br />CHESTNUT, FEDERAL PROJECT NO. ESPL 5063(138) <br />TOTAL CONTRACT AMOUNT: $ �q Z,�j�s�I • a u <br />BID DATE: <br />BIDDER'S NAME: �-�- <br />ONTRACT UDBE GOAL: <br />ONTRACT <br />ITEM OF WORK AND DESCRIPTION <br />Cert.No.ofUDBE <br />NAME OF UDBEs <br />DOLLAR AMOUNT <br />ITEM NO. <br />OR SERVICES TO BE <br />AND EXPIRATION <br />Must be certified on the date bids <br />UDBE <br />SUBCONTRACTED OR MATERIALS <br />DATE <br />are opened - include UDBE <br />O BE PROVIDED <br />add ress and hone number) <br />12-7 -1 <br />,vtcr, <br />7 .- <br />i <br />Ga iM W-Si ._ - <br />U . vt <br />CT- do ..z2 <br />I r✓ <br />U - <br />P A0y qkqJiAtyb& <br />x boy <br />co <br />For Local Agency to Complete: <br />Local <br />Total Claimed <br />$ W a I Z o d <br />�-- <br />Agency Contract Number: <br />Participation <br />-- <br />Federal Aid Project Number: <br />Federal Share: <br />V <br />Contract Award Date: <br />Local Agency certifies that all information is complete and accurate. <br />Rolo�v -� vie Q� <br />Print <br />nt Name Signature Date <br />Signature of Bidder / <br />Local Agency Representative <br />Area Code) Telephone Number: <br />For Caltrans Review: <br />Date (Area Code) Tel. No. <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />Local Agency Bidder - UDBE Commitment (Rev 3/09) <br />-5 X0-0- t i Copy — rax or scan a copy to the Caitrans District Local Assistance Engineer (DLAE) within 15 days of award. Failure to <br />send a copy to the DLAE within 15 days of award may result in de- obligation of funds for this project. <br />• (2) Copy -- Include in award package to Caltrans District Local Assistance <br />(3) Original — Local agency files <br />TO BE INCLUDED IN BID PACKAGE <br />BP 20 of 29 <br />