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Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) <br />(Inclusive of all DBEs at bid proposal) <br />NOTE: PLEASE REFER TO INSTRUCTIONS IN APPENDIX H <br />AGENCY: City of Santa Ana LOCATION: FLOWER ST BETWEEN SUNFLOWER AV TO <br />CARTH[R2 13LVD <br />PROJECT DESCRIPTION: PROJECT N0. 12-2620 RPSTPLE 50630 (143) FLOWER STREET BIKE TRAIL GAP CLOSURE_ <br />TOTAL FEDERAL CONTRACT AMOUNT:$ 500,0400 <br />ID DATE: �Ll & L, / Z,V 03 <br />BIDDER'S NAME: Green Giant Lan 3capeg inc. <br />CONTRACT <br />ITEM OF WORK AND DESCRIPTION <br />Cert. No. of DBE <br />NAME OF DBEs DOLLAR AMOUNT <br />ITEM NO. <br />OR SERVICES TO BE <br />AND EXPIRATION <br />(Must be certified on the date bids DBE <br />SUBCONTRACTED OR MATERIALS <br />DATE <br />are opened - include DBE address <br />TO BE PROVIDED <br />and phone number) <br />lEl <br />For Local Agency to Complete: <br />�, �� <br />Total Claimed s_lCt.!_3')f�-1 <br />Local Agency Contract Number: <br />Participation L _I !_ <br />Federal Aid Project Number: <br />Federal Share: <br />Contract Award Date: <br />Local Agency certifies that all information is complete and accurate. <br />S nature Bidder <br />01 <br />Print Name Signature Date <br />Local Agency Representative <br />Area Code Telephone Number. <br />Date WI p 11 (Area Code) Tel. No. <br />For Caltrans Review: <br />Print Name Signature Date <br />Caltrans District Local Assistance Engineer <br />Local Agency Bidder- DBE Information (Rev 3/09) <br />Distribution: (1) Copy— Fax or scan scary to the Caltrans District Local Assistance Engineer (1)LAE) within 15 days of award. Failure to <br />send a copy to the DLAE 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 21 of 29 <br />