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Local Assistance Procedures Manual EXHIBIT I0-02 <br />Local Agency Proposer DBE Information (Consultant Contracts) <br />EXHIBIT 10-02 Local Agency Proposer DBE Information (Consultant Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM <br />LOCAL AGENCY: City of Santa Ana LOCATION: Santa Ana California <br />PROJECT DESCRIPTION: CM Services for the First Street Bridge Replacement over the Santa Ana River, 06-1723 <br />TOTAL CONTRACT AMOUNT ($): $TBD <br />PROPOSER'S NAME: Hill International Inc. <br /> <br />WORK <br />ITEM NO. <br /> <br /> <br />1- DESCRIPTION OR SERVICES TO BE <br />SUBCONTRACTED (or contracted if <br />the proposer is a DBE) <br />_ <br />Office En ineerin / DBE CERT NO. <br />AND EXPIRATION <br />DATE <br /> <br />CUCP #20160 NAME OF EACH DBE <br />(Must be certified at the time <br />proposals are due - include DBE <br />address and hone number) <br />Diaz Consultants Inc. DOLLAR AMOUN T OF <br />EACH DBE <br /> <br /> <br />TBD <br /> Schedulin Su ort ..414/2013 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />For Local Agency to Complete: <br /> <br />Local Agency Contract Number: <br />Federal-Aid Project Number: <br />Federal Share: <br />Contaret Award: <br />Local A <br />if <br />h <br />h <br />Total Claimed DBE <br />Participation <br />$ TBD <br /> <br />717 <br />gency cert <br />ies t <br />at t <br />e DBE certifications have been verified and all <br />informations is complete and accurate. <br /> <br />Print Name Signature Date Signature of Proposer <br />vzecd 11 (949) 474-2908 <br />Local Agency Representative <br />Area Code) Telephone Number: c (Area Code) Tel. No. <br />Michael Tahan <br />For Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer Person to Contact (Please Type or Print) <br />Local Agency Proposer DBE Information (Consultant Cotittarcts) <br />(Rcv 6(27/09) <br />Nstribution: (1) Copy - Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days after contract execution. <br />Failure to send a copy to the DLAE within 15 days after contract execution may result in deobligation of funds for this project. <br />(2) Original - Local agency files <br />Page 10-74a <br />.PP 09-02 July 31, 2009 <br />MILIL City of Santa Ana I Public Works Agency Page 1 17 <br />First Street Bridge Replacement I Construction Management