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Local Assistance Procedures Manual <br />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 />LOCALAGENCV: City of Santa Ana LOCATION: Fisher Park Butterfly & Bird Ha <br />PROJECT DESCRIPTION: 11 -2606: Fisher Park Butterfly & Bird Habitat <br />TOTAL CONTRACT AMOUNT:$ (amount bid for project 11 -2606) <br />BID DATE: 04/17/2013 <br />BIDDER'S NAME: Hondo Company, Inc. <br />CONTRACT HOBE GOAL: <br />CONTRACT <br />ITEM NO. <br />ITEM OF WORK AND DESCRIPTION <br />OR SERVICES TO BE <br />SUBCONTRACTED OR MATERIALS <br />0 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 />Landscaping <br />uena Vista Landscape <br />69.000 <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 />Print Name Signature Date <br />Local Agency Representative <br />Area Code Telephone Number: <br />Total Claimed DBE <br />Participation <br />$69 ,000 <br />42 o/a <br />Signature o 'Bid <br />rI�W &1/x(00 <br />Date f (Area Code) Tel o. <br />s <br />For Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />Perso»to Contact (Please Type or Print) <br />Local Agency Bidder DBE In£onnation(Construotion Concocts) <br />(Rev 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 />itat <br />Page 15-32a <br />LPP 09 -02 July 31, 2009 <br />