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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 IN APPENDIX <br />//�� � <br />\l L ��a�///�///1 <br />GENCV: ����� /liLY/��_ LOCAT ON:_ �l�i/L�/I�IL�L,IJtL(/'IJYI�!!J� <br />_ <br />L 9 <br />ROJECT DESCRIPTION: PROJ ECT N0 �1ia77 �91�d,� lJA1i ��/\//J t/� —� <br />Z <br />p�/ <br />OTAL FEDERAL CONTRACT' AMOUNT: $ �� �O /'�Q <br />BID DATE: O <br />//��2 ' <br />IDDER'S NAME: C_JY�/sl� � /Ow � _ <br />ONTRACT <br />ITEM OF WORK AND DESC RIPT'ION <br />ert. No. of DBE <br />AME OF DBEs <br />DOLLAR AMOUNT <br />ITEM NO. <br />R SERVICES TO BE <br />ND EXPIRATION <br />Must be certified on [he date bids <br />BE <br />SUBCONTRACTED OR MATERIALS <br />DATF_ <br />re opened - include DBE address <br />O BE PROVIDED <br />nd hone number) <br />i - ►�i�s .. <br />�. <br />YTE <br />W. <br />or Local Agency to Complete: <br />-/y�� _ <br />$ <br />Local Agency Contract Number: _ <br />Patrtlic patioo <br />� " ����� <br />Federal Aid Project Number: <br />Federal Share: <br />l� <br />—]���% <br />ontract Award Date: <br />ocal Agency certi Fies [hat all information is complete and accurate. <br />B� J %/ <br />Print Name Signature Date <br />Signature of Bidder <br />Local Agency Representative <br />Area Code Tele hone Number: <br />��/ <br />�/�����z (SIB)963 -807/ <br />Daft- (Ama Code) "rel. No. <br />or Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />Local Agency Bidder - DBG Information (Rev 3/09) <br />Distribution: (1) Copy —Fax or scan a copy to the Caltrans District Local Assistance Engineer (DEAF) within 1 5 days of award_ Failure to <br />send a copy to the DEAF: 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 />TO BE INCLI;DED [N BID PACKAGE <br />BP 22 of 30 <br />