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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 />articipa[ion will be reported. <br />AGENCY:- -lt--?.t????-??yx?5 LOCATION:??'V <br />PROJECT DESCRIPTION: Memorial Pazk <br />CONTRACT NUMBER:- ? ?7 Z <br />FEDERAL-AID PROJECT NUMBER: \ \l S2? <br />TOTAL CONTRACT AMOUNT: $ <br />FEDERAL SHARE (For local agency to\; mple[e) : $ <br />BID DATE: ???-? <br />BIDDER'S NAME: ? a?S ???r`n\T s'C <br />A rlv GTl TiCPTI TIRF !'(1NTR A(?T AVAII ARri TTY GTIV [C(1RY PerrPr,fa vrr <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 the 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 Firms being participating in [he project, regazdless of <br />Names of the Fitst Tier DBE Subcontractors and [heir respective item(s) of work <br />iet Total Claimed <br />. <br />fisted above should be consistent, where applicable, wish the names and items of work in <br />he "Lis[ of Subcontractors" submitted with your bid. Provide copies of [he DBEs' <br />uo[es, and if applicable, a copy of joint venture agreements. pursuant to [he <br />Subcontractors Listing Law and [he Special Provisions. pazicipa[ion <br />1. 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 not [o be performed or furnished by DBE, describe exact portion of <br />erformed or furnished by DBE <br />item [o be S? na[u fBI <br />Zd.? ? _yO <br />. <br />p <br />. See Section "Disadvantaged Business Enterprise (DBE)," of [he Special Provisions <br />(construction contracts); [o determine how [o count [he participation of DBE firms. <br />Date (Area Code) Tel. No. <br />^ ` . r, <br />Y?i?Sa M?_ <br /> <br />Locat Agency nwUtx - IJnC tntormauon tKev J/U VUb) <br />Distribution: (1) Copy -Fax immediately to [he Caltrans District Local Assistance Engineer (DEAF) upon award. <br />(2) Copy -Include in awazd package [o Caltrans District Local Assistance <br />(3) Original -Local agency files <br />BP 29 of 37