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EXHIBIT 15 -G LOCAL AGENCY BIDDER DBE COMMITMENT (CONSTRUCTinN CONTRA rTal <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM <br />LOCAL AGENCY: City of Santa Ana LOCATION: PROJECT: 12 -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: $ 289,923.00 <br />BID DATE: 413/2013 <br />BIDDER'S NAME: PTM General Engineering Services Inc. <br />CONTRACT DBE GOAL: 9.65% <br />CONTRACT ITEM <br />O. <br />TBM OF WORK AND DESCRIPTION OR <br />SERVICES TO BE SUBCONTRACTED <br />R MATERIALS TO BE PROVIDED (or <br />ontracted if the bidder is a DBE) <br />BE CERT NO. <br />EXPIRATION <br />DATE <br />NAME OF EACH DBE <br />(Must be certified on the date bids <br />are opened - include DBE address <br />and phone number) <br />DOLLAR AMOUNT <br />BE <br />Item 1 - 5 <br />Pin. of electrical material supply <br />37133 <br />Lyteforms <br />$34,438 <br />13841 Roswell Ave. Ste A <br />'him, rApl71n <br />Item 6, 7 <br />Ptn. of electrical installation <br />38033 <br />Traffic Loops Crackfilling, Inc. <br />$7,315.00 <br />946 S. Emerald Street <br />Anaheim CA 92804 <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 />� 27 977 80 <br />9.65 % <br />Contract Award Date: <br />Local Agency certifies that all DBE certifications have been verified and <br />information is complete and accurate. <br />Print Name Signature Date <br />Local Agency Representative <br />(Area Code) Telephone Number: <br />Elizabeth H. Mendoza de McRae, Presldent/CFO <br />PTM General Engineering Services Inc. <br />Signorine of Bidder <br />951- 710 -1000 <br />14/2120113 <br />te (Area Code) Tel. No. <br />liz . Mendoza the McRae <br />Person to Contact (Please Type or Print) <br />Local Agency Bidder DBE Commitment (Consnmctioa Contracts) <br />(Rev 6/26/09) <br />Distribution: (1) Copy —Fax or scan a copy to the Calirans District Local Assistance Engineer (DLAE) within 30 days of contract execution. Failure to <br />send a copy to the DLAE within 30 days ofcoutrri0 execution may result in de- obligation of finds for this project. <br />(2) Copy— Include in award package to Cnlnuns District Local Assistance <br />(3) Original — Local agency files <br />TO BE INCLUDED IN BID PACKAGE <br />BP 19 of 27 <br />