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<br /> <br /> <br /> <br /> 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 /> <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 /> <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 /> <br /> PROPOSER'S NAME: AECOM Technical Servuces <br /> <br /> CONTRACT DESCRIPTION OR SERVICES TO BE BE Cert. No. AME OF DBEs ERCENTAGE OF <br /> ITEM N0. SUBCONTRACTED ND EXPIRATION (Must be certified on the date bids BE <br /> ATE are opened -include DBE address <br /> and phone number) <br /> Task IV.G Geotechnical Investlgatlon CP Firm No. 6956, Earth Mechanics, Inc. 4.0% <br /> exp. 12/19/2013 17660 Newhope St., Ste. E <br /> ountaln Valley, CA 92708 <br /> 714.751.3826 <br /> Task IV.E Field Survey/Topography CUCP #21228, Coast Surveying Inc. 5~3% <br /> etro #287, exp. 15031 Parkway Loop, Ste. B <br /> 12/4/2013 Tustin, CA 92780 <br /> (714) 918-6266 <br /> For Local Agency to Complete: <br /> Total Claimed ~ tbd <br /> Local Agency Contract Number: Participation <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 /> w <br /> Signature of Proposer Pat Somerville, PE <br /> Print Name Signature Date <br /> Local Agency Representative 4/h/2~1 ~ 714 5h7 2755 <br /> Date (Area Code) Tel. No. <br /> (Area Code) Telephone Number: <br /> For Caltrans Review: Pat Somerville, PE <br /> Person to Contact (Please Type or Print) <br /> <br /> Print Name Signature Date <br /> Caltrans District Local Assistance Engineer 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 IS 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 />