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EXHIBIT D <br />Local Agency Proposer UDBE Commitment (Consultant Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS <br />AGENCY: LOCATION: PROJECT <br />DESCRIPTION: CONTRACT GOAL: <br />$ PROPOSAL <br />DATE: PROPOSER'S <br />NAME: <br />NAME OF UDBEs (Must be <br />WORK ITEM <br />NO. <br />DESCRIPTION OR SERVICES TO <br />BE SUBCONTRACTED <br />DBE Cert. No. AND <br />EXPIRATION DATE <br />certified on the date the <br />proposals are opened - include <br />UDBE address and phone <br />PERCENTAGE <br />AMOUNT OF EACH <br />UDBE <br />number <br />For Local Agency to Complete: Local Agency Contract Number: <br />Total Claimed Participation <br />Federal Aid Project Number: <br />Federal Share: <br />Proposal Award <br />Date: Local Agency <br />Q <br />$ <br />certifies that the UDBE certification(s) has been verified and all information is <br />complete and accurate. <br />po <br />Print Name Signature Date Local <br />Agency Representative (Area Code) Telephone Number: <br />Signature of Proposer <br />For Caltrans Review: <br />Print Name <br />Signature Date Caltrans District Local Assistance Engineer <br />Date <br />(Area Code) Tel. No. <br />Local <br />Agency Bidder - UDBE Commitment (Rev 3/09) <br />Page 43 of 48 <br />19H -47 <br />