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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 ON APPENDIX F <br />AGENCY: LOCATION: PROJECT NO. 10-6704: TRAFFIC SIGNAL INSTALLATION ON <br />CI`VICICENTER DR 8r. PACIFIC ST <br />PROJECT DESCRIPTIONS PROJECT NO. ?(_ S?G\ ?? T???.16 ?'t? ?LCJ-?L?/ Ga-??IU? / IZ -6763 <br />OTAL CONTRACT AM?((???nUNT: $ <br />BID DATE. ?`?? l{, w ¦.e . w e. -1 r_ <br />BIDDER'S NAME: <br />ONTRACT <br />ITEM NO. ITEM OF WORK AND DESCRIPTION <br />R SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED ert. No. of DBE <br />ND EXPIRATION <br />ATE AME OF DBEs <br />Must be certi£ed on the date bids <br />re opened -include DBE address <br />nd hone number DOLLAR AMOUNT <br />BE <br />Y \q\ _ <br /> 11? <br /> <br />I - <br /> <br /> <br /> <br /> <br /> <br />For Local Agency to Complete: <br /> <br />L <br />l <br />C <br />N <br />b <br />Total Claimed <br />i <br />i <br />$ (?? ?(? <br />oca <br />Agency <br />ontract <br />um <br />er: <br />Federal Aid Project Number: <br />Federal Share: $18.040 Partic <br />pat <br />on <br /> <br />? % <br />ontrnc[ Award Dale: <br />Local Agency certifies that all information is complete and acc urate. <br />Print Name Signature <br />Local Agency Representative Date Signature of Bidder <br />2 t``,, <br />?,s? J 12 ??- ?ly _` 333 <br />Area Code Tele hone Number- <br />FOC Caltrans Review: <br />Print Name Signature <br />Caltrans DlStrlc[ Local Assistance Engineer <br />Date Date (Area Code) Tel. No. <br /> <br />Local Agency Bidder -DBE Information (Rev 3/09) <br />Distribution: (1) Copy -Fax or scan a copy [o the Caltrans District Local Assistance Engineer (DLAE) within 15 days of award. Failure to <br />send a copy to the DLAE within 1 5 days of award may result in de-obligation of funds for [his project <br />(2) Copy -- Include in award package to Caltrans Disvict Local Assistance <br />(3) Original -Local agency £Ies <br />TO BE INCLUDED IN BID PACKAGE <br />BP 22 of 32