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Local Agency BIDDER-DBE (Construction Contracts)-Information <br />e successful BIDDER must execute and return the LOCAL AGENCY BIDDER -DBE INFORMATION form, even if no DBE <br />azticipation will be reported- <br />AGENCY: Y?KrA! =YW ? ?i?? ?+?"'S LOCATION: <br />PROJECT DESCRIPTION: Madison Park <br />CONTRACT NUMBER:- IOISSg <br />FEDERAL-AID PROJECT NUMBER: tc-iZSS? <br />TOTAL CONTRACT AMOUNT: $ <br />FEDERAL SHARE (For local agen?yy??to complete) : $ <br />BID DATE: y?Zi7'GY-??? <br />BIDDER'S NAME: '??7uG Kk-?-'e-?>c< ?u-C <br />ADVERTISED DBE CONTRACT AVAILABILITY ADVISORY Percentaee: <br />ONTRACT <br />ITEM NO. EM OF WORK AND DESCRIPTION <br />R SERVICES TO BE <br />UBCONTRACTED OR MATERIALS <br />O BE PROVIDED ? BE Cert. No. <br />D EXPIRATION <br />ATE AME OF DBEs ? <br />Mus[ be certified on the dale bids <br />? re 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 paz[icipating in [he project, regazdless of <br />ier. Names of [he First Tier DBE Subcontractors and [heir respective item(s) of worK Total Claimed <br />fisted above should be consistent, where applicable, with the names and items of work in <br />he "Lis[ of Subcontractors" submitted with your bid. Provide copies of [he DBEs' <br />uotes, and if applicable, a copy of joint venture agreements. pursuant to [he <br />Subcontractors Listing Law and [he Special Provisions. Participation <br /> <br /> <br />f0 <br />I. 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 not to be performed or furnished by DBE, describe exact portion of <br />item to be performed or furnished by DBE. g ur D <br /> <br />? ?? ~ Li ? '?+ <br /> <br />3. See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions <br />(construction contracts); [o determine how [o count [he participation of DBE firms. Da[ (Area Code) Tel. No. <br /> <br />?- . __A ?? \?C <br /> <br />C.ocal Agency BIDDER -DBE Information (Rev 5/01/06) <br />Distribution: (1) Copy -Fax immediately [o [he Caltrans District Local Assistance Engineer (DEAF) upon awazd. <br />(2) Copy -Include in award package to Caltrans Dis[ric[ Local Assistance <br />(3) Original -Local agency £les <br />BP 28 of 37