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Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) <br />(Inclusive of all DBEs at bid proposal) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX H <br />AGENCY City of Santa Ana.---- LOCATION,. Windsor Park <br />ROJEC'I'DESCRIPTION. ProiectNo 13-7514 <br />TOTAL FLULRAL, CONTRACT AMOUNT. $100,000 <br />BIDDATEi 01/29!2013 <br />—7 <br />L;G77 <br />BIDDER'S NAME <br />ITEM M 0 -WO co' -of DBE <br />,ONTRACT ITEM OF WORK AND DESCRIPTION 'crt. No of <br />PI TI( <br />ND EXPIRATION <br />NDL EXPIRATION <br />NAME OF DBEs DOLLAR AMOUNT <br />NAME DBEs <br />1, date bids B <br />Must be certified on the date bids H <br />certified Must <br />I� <br />JR SERVICES <br />ITEM NO R SERVICES TO BE <br />Sr VIC �c Al <br />1,113CONTRAc-i-ED OR MATERIALS )ATE <br />B;N RV <br />d address <br />reopened - include DBE address <br />n- c <br />FO BE PROVIDED <br />OCK 1 <br />dphonenumber) <br />d It n nor <br />IN C4 <br />For Local Agency to Complete: <br />"total Claimed <br />1,ocal Agency Contract Number <br />Participation <br />Federal Aid Project Nunitx.-r <br />Federal Share <br />ontractAwardDate <br />Local Agency cerlifics that all information is complete and accurate <br />Signature of Bidder <br />Print Name n .1c Daw <br />Local Agency Representative <br />L <br />Area <br />3 7 7e, <br />For Caltrans Review' <br />Date (Area Code) Tcl No <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />Local Agency Bidder DBE 1nfon-!,— 3,09) <br />I <br />Distribution. (1) Copy - Fax or scan a copy to the Caltrans District Local Assistance Engineer (bLAE-:) within 15 days of award Failure to <br />send a copy to the DI.AF. within 15 days of award may result in de-obligation of funds for this project <br />(2) Cory - Include an award package to Caltrans District Local Assistance <br />(3) Original - Local agency flies <br />TO BE INCLUDED IN BID PACKAGE <br />BP 22 of 30 <br />