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Local Agency BIDDER-DBE (Construction Contracts)-Information <br />The successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DB? <br />participation will be reported. <br />AGENCY:- ?l?t? Y?kl??? LOCATION: S T? <br />PROJECT DESCRIPTION: Cam esino Pazk <br />CONTRACT NUMBER:- ??7? "? <br />FEDERAL-AID PROJECT NUMBER: \??5?`-\ <br />TOTAL CONTRACT AMOUNT: $ <br />FEDERAL SHARE (For local agencyy to complete) . $ <br />BBJ DATE: V1 -ZCJ- ZO ?? <br />BIDDER'S NAME: "t2,ywS ?-741;1 T \ ?_f- <br />ADVERTISED DBE CONTRACT AVAB_ABILITY ADVISORY Percentane: <br />ONTRACT <br />ITEM NO. EM OF WORK AND DESCRIPTION <br />OR SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED ? BE Cert. No. <br />ND EXPIRATION <br />ATE AME OF DBEs ' <br />Must be certified on [he date bids <br />re opened -include DBE address <br />nd hone number) OLLAR AMOUNT <br />BE' <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />PORTANT: Identify all DBE (inns being participating in the project, regazdless of <br />ier. Names of [he Firs[ Tier DBE Subcontractors and [heir respective item(s) of work Total Claimed <br />fisted above should be consistent, where applicable, with [he names and items of work in <br />he "List of Subcontractors" submitted with your bid. Provide copies of [he DBEs' <br />uo[es, and if applicable, a copy of joint venture agreements. pursuant [o [he <br />Subcon[racmn Listing Law and the Special Provisions. Participation <br /> <br /> <br />J0 <br />1. Enter DBE prime and subcontractors certification number. Prime contractors shall <br />indicate all work to be performed by DBEs including work performed by its own <br />forces. <br />If 100% of item is no[ to be performed or famished by DBE, describe exact portion of <br />item to be performed or famished by DBE. ign u o ID R <br /> <br />?\ \?\' i? '? <br /> <br />3. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions <br />(construction contracts); [o determine how to count [he participation of DBE firms. Dale (Area Code) Tel. No. <br /> <br />?QNS ?? ??_\ ?? <br /> <br />Local Agency BIDLJY.K - ll13t lntormattion (Rev 5/01/06) <br />Distribution: (1) Copy -Fax immediately to [he Ca][rans Dis[ric[ Local Assistance Engineer (DLAE) upon award. <br />(2) Copy -Include in awazd package [o Cal[rans Dis[ric[ Local Assistance <br />(3) Original -Local agency files <br />BP 25 of 37