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Local Assistance Procedures Manual EXHIBIT 10 -01 <br />Local Agency Proposer UDBE Commitment (Consultant Contracts) <br />EXHIBIT 10 -01 Local Agency Proposer UDBE Commitment (Consultant Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM <br />LOCAL AGENCY: LOCATION: <br />PROJECT DESCRIPTION: <br />PROPOSAL DATE: <br />PROPOSER' S NAME: <br />CONTRACT UDBE GOAL ( %): <br />WORK <br />ITEM NO. <br />DESCRIPTION OR SERVICES TO BE <br />SUBCONTRACTED (or contracted if <br />the proposer is a UDBE) <br />UDBE CERT NO. <br />AND EXPIRATION <br />DATE <br />NAME OF EACH UDBE <br />(Must be certified at the time <br />proposals are due - include UDBE <br />address and phone number) <br />PERCENT <br />PARTICIPATION <br />OF EACH UDBE <br />For Local Agency to Complete: <br />Local Agency Proposal Number: <br />Federal -Aid Project Number: <br />Federal Share: <br />Total Claimed UDBE <br />Commitment <br />Proposal Date: <br />Local Agency certifies that the UDBE certifications have been verified and all <br />information is complete and accurate /unless noted otherwise. <br />Print Name Signature Date <br />Local Agenc Representative <br />(Area Code) Telephone Number: <br />Signature of Proposer <br />Date (Area Code) Tel. No. <br />Person to Contact (Please Type or Print) <br />Local Agency Proposer UDBE Commitment (Consultant Contracts) <br />(Rev 6/27/09) <br />Distribution: (1) Original - Local agency files <br />Page10 -73 <br />LPP 09 -02 July 31, 2009 <br />