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Local Assistance Procedures Manual EXHIBIT 10 -01 <br />Consultant Proposal DBE Commitment <br />EXHIBIT 10 -01 CONSULTANT PROPOSAL DBE COMMITMENT <br />(Inclusive of all DBEs listed at bid proposal. Refer to instructions on the reverse side of this form) <br />Consultaiiit to ConipJete, tfiis .Section. <br />1. Local Agency Name: <br />2. Project Location:_, <br />3. Project Description:. <br />4. Consultant Name: <br />S. Contract DBE Goal %: <br />DBE Commitment Information <br />—r <br />6. Description of Services to be Provided 1 7. DBE Finn 1 8. DBFceW.--7 9. DB8 °% 1 <br />16, Local Agency Contract Number: <br />17, Federal -aid Project Number <br />18, Proposed Conant Execution Date: <br />Local Agency certifies that all DBE certifications are valid and the <br />information on this form is complete and accurate: <br />11. Preparer's Signature <br />11 Preparer's Name (Print) <br />19, Local Agency Representative Name (Print) <br />20. Local Agency Representative Signature 21. Date <br />22, Local Agency Representative Title 23, (Area Cade) Tel. No. <br />13. Preparer's Title <br />14. Date 15. (Area Code) Tel. No, <br />Distribution: (1) Original — Consultant submits to local agency with proposal <br />(2) Copy — Local Agency tiles <br />Page I of 2 <br />LPP 13 -01 May 8, 2013 <br />251 -42 <br />