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Local Agency BIDDER-DBE (Construction Contracts)-Information <br />he successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE <br />articipa[ion will be reported- <br />?rC?L-]l.[? ????yC?? LOCATION: ?? <br />AGENCY:- <br />PROJECT DESCRIPTION: El Salvador Pazk <br />CONTRACT NUMBER:- i\-7S3S <br />FEDERAL-AID PROJECT NUMBER: ? l-! S? <br />TOTAL CONTRACT AMOUNT: $ <br />FEDERAL SHARE (For local agencyy to ?om?? pplete) : $ <br />BID DATE: ?? - LC7 ? LC7\ \ <br />BIDDER'S NAME: `P??i._? ?. r?A T?T A-.c^ <br />Trcar?riaa rr?nrro er-r evon can i'rv er?vrc?ov ae...P..?? <br />ONTRACT <br />ITEM NO. TEM OF WORK AND DESCRIPTION <br />R SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED ? BE Cert. No. <br />D EXPB2ATION <br />ATE AME OF DBEs t <br />(Must be certified on [he date bids <br />aze opened -include DBE address <br />and hone number) OLLAR AMOUNT <br />BE' <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />PORTANT: Identify all DBE firms being participating in the project, regazdless of <br />Names of [he Firs[ Tier DBE Subcontractors and [heir respective item(s) of work <br />ier Total Claimed <br />. <br />is[ed above should be consistent, where applicable, with [he names and items of work in <br />he "Lis[ of Subcontractors" submitted with your bid. Provide copies of [he DBEs' <br />notes, and if applicable, a copy of join[ venture agreements. pursuant [o [he <br />ubcon[rac[ors Listing Law and the Special Provisions. participation <br />I. Enter DBE prime and subcontractors certification number. Prime contractors shall <br />indicate all work [o be performed by DBEs including work performed by its own <br />- <br />forces. <br />If 100% of item is no[ to be performed or famished by DBE, describe exact portion of <br />erformed or famished by DBE <br />item [o be Signa o ID R <br /> <br />, ?\ <br />. <br />p <br />. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions <br />(cons[mction contracts); [o determine how to count [he participation of DBE firms Da[ (Area Code) Tel. No. <br /> <br />??;? \. Y ?, <br />"`? <br /> r <br />,sr??y ar,?,.L,? - ?.nt. ,?,?a.,,...?.. r.«? ?,?,,.,?? <br />Distribution: (1) Copy -Fax immediately [o [he Cal[rans Dis [ric[ Local Assistance Engineer (DEAF) upon award. <br />(2) Copy -Include in awazd package [o Cal[rans District Local Assistance <br />(3) Original -Local agency files <br />BP 26 of 37