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- ? > -. <br />Exhibit 15-G 1 Local Agency Bidder UDBE Commitment (Construction Contracts) <br />N()TF:s <br />PL?AS? REFER Tn iNSTRi7CTinN? nN THE REVERSE Si <br />nF (?F THiS FnRM <br />n <br />y <br />GENCY. l i???? ?K??}q ? Vlp LOCATION: F?I'ls<P_ I ? ?L-SI ???1 { i Q, ? ??'. ?i e_ <br />R _ ____ -_ _ . --- -- <br />OTAL CONTRACT AMOUNT: $ ? •, O aI ?) 2 ?I S <br />ID DATE: ??brv rn?l_? ? ,?/?L ) <br />IDDER'S NAME:_?1,???1r j C?V1 ?- <br />.ONTRACT UDBE GOAL: R I ? 70 <br />ONTRACT <br />ITEM NO. TEM OF WORK AND DESCRIPTION <br />R SERVICES TO BE ert. No_ of UDBE <br />D EXPIRATION AME OF UDBEs <br /> <br />(Mus[ be certified on the date bids OLLAR AMOUNT <br /> <br />DBE <br /> UBCONTRACTED OR MATERIALS ATE are oprned -include UDBE address - <br /> O BE PROVIDED and hone number <br />? s+. ? - 1 O 4 ti Er.l oil Tr• <br /> II Y <br /> 203 D <br /> <br /> D <br /> <br /> <br /> <br /> <br /> <br />or Local Agency to Complete: <br />al Agency Contract Number: Participation $ 20 3 S 8 3 .9 0 <br />ederal Aid Project Number: <br />ederal Share: I $ cJ o/p <br />ontract Award Date: <br /> <br />al Agency certifies that all information is complete and accurate. <br /> Rot>?r-F ??edl?ylYic?P i <br />'nt Name Signature Date Signature of Bidder _ <br />cal Agrncy Representative <br /> <br />Area Code Tel hone Numb <br />r / <br />1.?5? ?.3 LO-? 10th <br />: <br />e <br />or C81tr8ns Review: Date 223/ I 1 (Area Code) Tel. No. <br />Print Name Signature Date - <br />Caltrans District Local Assistance Engineer Local Age>wy Bidder -UDBE Commitment (Rev 3/09) <br />u?stnounon: l+? ropy - rax or scan a copy to the caitrans 17?stnct Local Assistance Engineer (DEAF) within 15 days of award. Failure: to <br />"- _ smd a copy to the DLAE within 15 days of award may resu]t 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 21 of 29