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EXHIBIT 15 -G LOCAL AGENCY BIDDER DBE COMMITDIENT (CONSTRUCTION CONTRACTS) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM <br />LOCAL AGENCY: City of Santa Ana LOCATION: PROJECT: I2 -6760: TRAFFIC SIGNAL <br />MODIFICATION ON McFADDEN AVE AT LYON ST <br />PROJECT DESCRIPTION: Traffic signal modification on McFadden Ave. & Lyon St. <br />TOTAL CONTRACT AMOUNT: <br />BID DATE: 4/3/2013 <br />BIDDER'S NAME: PTM General Engineering Services Inc. <br />CONTRACT DBE GOAL: 9.65% <br />CONTRACT ITEM <br />O. <br />ITEM OF WORK AND DESCRIPTION OR <br />SERVICES TO BE SUBCONTRACTED <br />OR MATERIALS TO BE PROVIDED (or <br />contracted if the bidder is a DBE) <br />USE CERT NO, <br />AND EXPIRATION <br />DATE <br />NAME OF EACH DBE <br />(Must be certified on the date bids <br />ire opened - include DBE address <br />and phone nrunber) <br />DOLLAR AMOUNT <br />DBE <br />For Local Agency to Complete: <br />Local Agency Contract Number; <br />Federal -aid Project Number: _ <br />Federal Share: $30,050 <br />Total Claimed DBE <br />Participation <br />k�'El,mb,th <br />$ <br />Coutract Award Date <br />Local Agency certifies that all DBE certifications have been i mifed and <br />information is complete and accurate, <br />H. Mendoza de McRae, President/CFO <br />PTM General Engineering Services Inc. <br />Signature of Bidder <br />4/2/2013 951 - 710 -1000 <br />Date (Area Code) Tel, No. <br />Elizabeth H. Mendoza de McRae <br />Print Name Signature Date <br />Local Agency Representative <br />(Area Code) Telephone Number: <br />Person to Contact (Please Type or Print) <br />Local Agency Hiddcr DHE Conmtifmavt (COnstnmtien ('ontracts) <br />(Rev 6/26/09) <br />Distribution: (1) Copy —Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 30 days of contract execution. Triton, to <br />send a copy to the DLAE within 30 days of contract execution miy result in de- obligation of fiords for this project. <br />(2) Copy— Include in award package to Caltrans District Food Assistance <br />(3) Original — Local agency files <br />TO BE INCLUDED IN BID PACKAGE <br />BP 19 of 27 <br />