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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 10-6705 TRAFFIC S[GNAL INSTALLATION ON <br /> 1 7 <br />r <br />" ST 8e KING ST <br />??pp ??? <br />PROJECT DESCRIPTION: PROJECT NO. TK?'n(_ S? -\ l <br />1 <br />- <br />?ONA, ?K?A,I a-Y16N , '? j v-6? 04 ? (0-.67oS-?? C Z---6`? b 3 <br />ONT <br />: <br />$ <br />O <br />? <br />? <br />^ <br />? <br />? <br />? <br />BI <br />D DAT <br />y??/??? ??qqyp??? <br />?? . <br />BIDDER'S NAME: <br />ONTRACT UDBE GOAL: <br />ONTRACT 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 certified on the date bids DBE <br /> SUBCONTRACTED OR MATERIALS ATE re opened -include UDBE address <br /> O BE PROVIDED nd hone number <br /> <br /> L <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />For Local Agency to Complete: <br />Total Claimed <br />$+ 1?O <br />Local Agency Contract Number: Participation ?l-?? <br />Federal Aid Project Number: <br />Federal Share: $22.120 ?? <br />ontract Award Date: <br />Local Agency certifies that all information is complete and acc urate. <br />Print Name Signature Dale Signature of Bidder <br />Local Agency Representative ?1 /` ?j <br />??? ' ` ??? ?V `? J <br />Area Code Tele hone Number: <br />For Caltrans Review: Date (Area Code) Tel. No. <br />Pnnt Name Signature Dale <br />Caltrans District Local Assistance Engineer Local Agency Bidder-UDBE Commitment (Rev 3/09) <br />Distribution: (1) Copy -Fax or scan a copy [o the Caltrans District Local Assl stance Engineer (DEAF) within 15 days of award. Failure to <br />send a copy to the DLAE within 1 5 days of award may result in de-obligaLOn of funds for [his 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 32