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Local Assistance Procedures Manual EXHIBIT 15 -G2 <br />Local Agency Bidder DBE Information (Construction Contracts) <br />EXHIBIT 15 -G2 LOCAL AGENCY BIDDER DBE INFORMATION (CONTRUCTION CONTRACTS) <br />(Inclusive of all DBEs including the UDBEs listed at bid proposal) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM <br />LOCAL AGENCY: ,LOCATION: <br />PROJECT DESCRIPTION: Madison Park Community Garden and Basketball Court <br />TOTAL CONTRACT AMOUNT:$ 624,000.00 <br />BID DATE, March 7, 2013 <br />BIDDER'SNAME: Hondo Company Inc. <br />CONTRACT UDBE GOAL: 8% <br />CONTRACT <br />ITEM NO. <br />ITEM OF WORK AND DESCRIPTION <br />OR SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />O BE PROVIDED (or contracted if the <br />bidder is a DBE <br />DBE CERT NO. <br />AND 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 />DBE <br />Trucker <br />38272 <br />L & T Enterprises <br />20,000.00 <br />5132 S Garth Ave <br />TA 110 491-4999 <br />- <br />For Local Agency to Complete: <br />Local Agency Contract Number <br />Federal -aid Project Number: <br />Federal Share: <br />Contract Award Date: <br />Local Agency certifies that all DBE certification have been verified and <br />Information is complete and accurate. <br />Total Claimed DBE <br />Participation <br />$ 20,000.00 <br />8 <br />_. _.__.. <br />Signahneo <br />4 — <br />3/7/13 714 43 0104 <br />Print Name Signature Date <br />Local Agency Representative <br />Area Code) Telephone Number <br />Dace (Area Code) Tel. No. <br />Robert Lloyd <br />For Caltrans Review: <br />Print Name Signature —But, <br />Caltrans District Local Assistance Engineer <br />Person to Contact (Please Type or Print) <br />Coutarcls) <br />(R ©c 6/26/09) <br />Distribution: (1) Copy —Fax or scan a copy to the Caltrans District Local Assistance Engineer (DLAE) within 15 days of contract execution. Failure to <br />send a copy to the DLAE within 15 days of contract execution 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 />Page 15-32a <br />LPP 09 -02 July 31, 2009 <br />