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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 <br />LOCATION F,I <br />Salvador Park <br />PROJECT DESCRIPTION. soiect No. 13 -7513 <br />TOTAL FF.DERAL CONTRACT AMOUNT. $120.000 <br />BIDDAIF 01 /29/2013 <br />BIDDER'S NAME. / \ -- I C = -'U <br />Jfi CU . <br />N1L <br />'ONTRACT <br />1'I-EM NO <br />1-I PM OF WORK AND DESCRIPTION <br />OR SERVICES TO BE <br />SUBCONTRACTED OR MA -1 F RIALS <br />'ert . No. of DBE, <br />AND EXPIRATION <br />DATE <br />NAME OF DBEs <br />Must be certified on the date bids <br />are opened - include DBE= address <br />DOLLAR AMOUN "I <br />DBE' <br />1 O BE PROVIDED <br />and phone number)_ <br />- <br />- <br />- <br />G <br />- <br />C HP Moe <br />For Local Agency to Complete: <br />r, <br />-total Claimed 00V <br />Local Agency Contract Number- - -__ -- <br />--- -- - -._ —_- <br />Participation - - — — <br />Federal Aid Project Number <br />Federal Share <br />o; <br />o <br />- ontract Award Dale. <br />Local Agency certifies that all information Is complete and <br />accurate <br />�- <br />Signature of Bidder <br />Pnnt Name Signature - -- pate - <br />Locai Agency Representative <br />�J <br />Area Code) Tcic hone Number: <br />Date (Area Code, Tel No <br />For Caltrans Review: <br />Print Name - -- Signature — <br />Caltrans District Local Assistance Engmeer <br />pate <br />I.ocjJ Agency B,d& -r - DBE Information (Rey ::09) <br />Distribution (1) Copy - Fax or scan a copy to the Caltrans District Local Assistance Lngmeer (ULAG) wttnm t f) days of award vauure to <br />send a copy to the DI, AE within 15 days of award may result In de- obfigaUon of funds for this project <br />(2) Copy -- Include in award package to Caltrans District Local Assistance <br />(3) Original - Local agency files <br />"I70 BE INCLUDED IN BID PACKAGE <br />BP 21 of 30 <br />