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7: 'a <br />M <br />Exhibit 15 -G2 Local Agency Bidder DBE Information (Construction Contracts) <br />(Inclusive of all DBEs at bid proposal) <br />p <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX H <br />AGENCY: l;t`i'4 CYP' U LOCATION:TQ.iA, <br />PROJECT DESCRIPTION: PROJECT NO. 13 -679& Cligstrant Avenue Clas 14R1 <br />TOTAL FEDERAL CONTRACT AMOUNT: $ 327.000 LL_, <br />BID DATE: <br />BIDDER'S NAML hit 0 {.6_ACAAeG T <br />ONTRACT <br />ITEM OF WORK AND DESCRIPTION <br />orl. No. of DBE <br />NAME OF DDEs <br />DOLLAR AMOUNT <br />ITEM N0. <br />OR SERVICES TO BE <br />AND EXPIRATION <br />Must be certified on the date bids <br />DBE <br />SUBCONTRACTED OR MATERIALS <br />DATE <br />are opened - include DBE address <br />O BE PROVIDED <br />and Phone number <br />17 S. <br />0312"7? <br />!Ah;orni, roHioi t <br />2 <br />42q o)tkely -'n Ave, <br />lAP l) G�. <br />For Local Agency to Complete: <br />Total Claimed <br />�j <br />'�` �� {�.J V0 <br />Local Agency Contract Number: <br />Participation <br />i <br />Federal Aid Project Number: <br />Pedeml Share: <br />1 �' ¢ % <br />Contract Award Date: <br />Local Agency certifies that nil information is complete and accurate. <br />eB <br />p6 °0 9 co— rutdUA� <br />Slgnafurc ofDiddcr <br />Print Name Signantre Dato <br />Local Agency Representative <br />Avea Code) Telephone Number: <br />Date 1H (Arco Code) Tel. No. <br />For Caltrans Review: <br />Prtn(Nmnc Sigmtmre Date <br />Caltrmis District Local Assistance Engineer <br />Lucnl Agewy Bidder - DBE Information (Rev 3/09) <br />Distribution: (1) Copy —Fax or scan it copy to the Callrans District Local Assistance Engineer (DLAE) within 15 days of award. Failure to <br />send a copy to the DLAE within 15 days ofaward may result in do- obligation of hods for flak project. <br />(2) Copy -- Include in award package to Callous District Local Assistance <br />ff (3) Original — Local agency t)los <br />TO BE INCLUDED IN BID PACKAGE <br />BP 19 of 27 <br />23A -30 <br />