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Information regarding a vendor's racial or gender ownership status will not be used <br />as a factor in the City's selection process for any contract. <br />Exhibit 10 -02 Local Agency Proposer DBE Information (Consultant Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM <br />AGENCY: City of Santa Ana LOCATION: 20 Civic Center Plaza, Santa Ana, CA 92701 <br />PROJECT DESCRIPTION: Project Study Report Equivalent and Conceptual Engineering Plans for Santa Ana Blvd. Grade Separation Project <br />TOTAL CONTRACT AMOUNT: $ 1.3 million <br />PROPOSAL DATE: 4/6/2010 <br />PROPOSER'S NAME: AECOM Technical Servuces <br />CONTRACT <br />DESCRIPTION OR SERVICES TO BE <br />DBE Cert. No. <br />NAME OF DBEs <br />PERCENTAGE OF <br />ITEM NO. <br />SUBCONTRACTED <br />AND EXPIRATION <br />(Must be certified on the date bids <br />DBE <br />DATE <br />are opened - include DBE address <br />and phone number) <br />Task IV.G <br />Geotechnical Investigation <br />UCP Firm No. 6956, <br />Earth Mechanics, Inc. <br />4.0% <br />exp. 12/19/2013 <br />17660 Newhope St., Ste. E <br />Fountain Valley, CA 92708 <br />714.751.3 826 <br />Task IV.E <br />Field Survey /Topography <br />CUCP #21228, <br />Coast Surveying Inc. <br />5.3% <br />Metro #287, exp. <br />15031 Parkway Loop, Ste. B <br />12/4/2013 <br />Tustin, CA 92780 <br />(714) 918 -6266 <br />For Local Agency to Complete: <br />Total Claimed <br />tbd <br />Participation <br />Local Agency Contract Number: <br />9.3 % <br />Federal Aid Project Number: <br />Federal Share: <br />Contract Award Date: <br />Local Agency certifies that the DBE certification(s) has been verified and all information <br />is complete and accurate. <br />Signature of Proposer Pat Somerville, PE <br />Print Name Signature Date <br />Local Agency Representative <br />4/6/2010 714 567 2755 <br />Date (Area Code) Tel. No. <br />(Area Code) Telephone Number: <br />Pat Somerville, PE <br />For Caltrans Review: <br />Person to Contact (Please Type or Print) <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />Local Agency Bidder -DBE Commitment(Rev 3/09) <br />Distribution: (1) Copy — Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days of contract execution. Failure to <br />send a copy to the DLAE within 15 days of contract execution may result in de- obligation of funds for this project. <br />(2) Original — Local agency fil <br />