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Exhibit 15-G1 Local Agency Bidder UDBE Commitment (Construction Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F <br />AGENCY: LOCATION: PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON <br />CIVIC CENTER DR Rc PACIFIC ST <br />?-p? <br />PROJECT DESCRIPTION: PROJECT NO. Z (0.{'7!(?G St?N,0.? ?11e:r?-p,??yt?CS?/1 ? '?-LOTFi?D?I? I D-670Si "???L-(?Zb <br />OTAL CONTRACT AMOUNT: $_ <br /> <br />BID DATE ??Z?'???wlsw.w:w ?.w?wwwiwww? Cwwiwe ? <br />?i <br />BIDDER'S NAME: <br />ONTRACT UDBE GOAL: <br />CONTRACT ITEM OF WORK AND DESCRIPTION ert. No. of UDBE AME OF UDBEs OLLAR AMOUNT <br />ITEM NO. R SERVICES TO BE ND EXPIRATION Must be certi£ed on the date bids DBE <br /> SUBCONTRACTED OR MATERIALS DATE re opened -include UDBE address <br /> O BE PROVIDED nd hone number <br /> 'L <br /> - ??? <br /> - U <br /> V t?C <br /> <br /> <br /> 3 ?' <br /> <br /> <br />For Local Agency to CUm plete: Total Claimed $ l-?? <br />l <br />Local Agency Contract Number: Participation ' <br />Federal Aid Project Number: <br />Federal Share: $22.120 ?? <br />on[rnct Award Date: <br />Local Agency certiF es that all information is complete and accurate. <br />Print Name Signature Date Signature of Bidder <br />Local Agency Representative <br />???? 12 ? ???? -\??? <br />Area Code Tele hone Number: <br />For Caltrans Review: Date (Area Code) Tel. No. <br />Print Name Signature Date <br />Calvans District Local Assistance Engineer Locnl Agency Bidder -UDBE Commitment (Rev 3/09) <br />UlStrlbat100: (1) Copy -tax or scan a copy to me Caltrans UIStrICt Local ASSISIBnce tng meet (LLAr.) WI[nm 1 ? ?ay5 Of award. tau LLre [O <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 21 of 32