Laserfiche WebLink
Exhibit 15 -G2 Local Agency Bidder DBE Information (Construction Contracts) <br />(Inclusive of all DBEs including the UDBEs listed at bid proposal) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F <br />AGENCY: City of Santa Ana _ LOCATION. Santa Ana <br />PROJECT DESCRIP'l ION. PROJECT No Residential Street Repair PH 16, Project No. 12 -6753, 12 -7531, 11 -2618 <br />OTAL FEDERAL CON'I -RACT AMOUNT SL _222-9-938 _ <br />BID DA'I L{ 02/14/2012 <br />BIDDERS NAME- R.J. NOBLE COMPANY <br />CONTRACT <br />ITEM N0, <br />ITEM OF WORK AND DESCRIPTION <br />OR SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED <br />Cert. No. cfDBE <br />AND EXPIRATION <br />DA H <br />NAME OF DBEs <br />Must be certified on the date bids <br />are opened - include DBE address <br />and hone nuntbei) __ _ <br />#4 <br />_ <br />Portion of sp a t I <br />CT -10447 <br />E.M. Oil Transport <br />08/02/2012 <br />1145 S. Taylor Ave <br />Montebello, Avenue, Ca <br />- - - -- <br />- <br />- - - - -- <br />- -- - <br />90640 -- - - - - -- <br />— - <br />323 - 722 -9088 <br />For Local Agency to Complete: <br />Local Agency Contract Number. <br />Federal Aid Prolec( Number. <br />Federal Share: <br />Contract Award Date. <br />Local Agency certifies that all information is complete and accurate <br />Print Name <br />Local Agency Representative <br />Area Code Telephone Number: <br />For Caltrans Review: <br />Signature <br />Total Claimed <br />Participation <br />AR AMOUNT —1 <br />250 Liquid tons <br />x $750.00 = <br />$187,500.00 <br />x 60% _ <br />$112,500.00 <br />S 112.500.00 <br />100 % <br />Steve Men za, Sigretary <br />Date Signetureol'Bidder <br />02/14/2012 714- 637 -1550 <br />Date (Area Code) "I -el No <br />Pi iut Name Signature Date <br />Caltrans District Local Assistance Engineer Local Agency Bidder - DBF Information (Rev 1;091 <br />Distribution: (1) Conv— Fax or scan a coov to the Caltrans District Local Assistance Engineer ( DLAE) within 15 days of award Failure to <br />send a copy to the DLAE: within 15 days of award may result in de obligation of funds for this project <br />(2) Copy -- Include in award package to Caltrans District Local Assistance <br />(3) Original — Local agency files <br />TO BE INCLUDED IN BID PACKAGE <br />BP 23 of 31 <br />