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Exhibit 15 -G2 Local Agency Bidder DBE Information (Construction Contracts) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX H <br />AGENCY: 1. �1T� "� LOCATION: SMICN�% Y-`FYV C]o �"� <br />PROJECT DESCRIPTION: PROJECT NO. <br />TOTAL FEDERAL CONTRACT AMOUNT: $_' :It C " <br />a 7 Itoo <br />BID DATE: 7.- 2-0 <br />BIDDERS NAME: Superior Paving Company, Inc.. <br />t a United Paving Company <br />CONTRACT <br />ITEM OF WORK AND DESCRIPTION <br />Cott. No. of DBE <br />NAME OF DBEs <br />DOLLAR AMOUNT <br />ITEM NQ <br />OR SERVICES TO BE <br />AND EXPIRATION <br />(Must be certified an the date bide <br />DBE <br />SUBCONTRACTED OR MATERIALS <br />DATE <br />are opened - include DBE address <br />TO BE PROVIDED <br />�i <br />and phone number) <br />Total Claimed <br />� <br />For Local Agency to Complete: <br />Local Agency Contract Number. <br />participation <br />) <br />Federal Aid Project Number: <br />- <br />Federal Share: <br />too <br />Contract Award Date: <br />Local Agency certifies that all information is complete and accurate. <br />�, <br />{ <br />Signature of Bidder <br />PrintName Signature Date <br />Local Agency Representative <br />(Area Code) Telephone Number: <br />Date (Area Code) Tel, No. <br />For Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engincei <br />Local Agency Bidder- DBE lnfomatim(Rev 3109) <br />Distribution: (l) Copy —Fax or scan a copy to the Caltums District Local Assistance Engineer (DLAE) within 15 days of award. Failure to <br />send a copy to the DUNE 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 22 of 30 <br />J <br />