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on <br />�33} <br />3 <br />Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) <br />(Inclusive of all DBEs at bid proposal) <br />p NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX H <br />AGENCY: &A. LOCATION: SW& ACA„ <br />PROJECT DESCRIPTION; PROJECT NO. 13-6796: Chestnut Avenue Class 11 Bikewnv from Standard Avcnue to Grand Aycnrc: CM -5063(1481 <br />TOTAL FEDERAL CONTRACT AMOUNT; $ 327.000 <br />BID DATE: L liq <br />BIDDER'SNAME;_ I ('(/,{'1 /y'yk& 7' <br />CONTRACT ITEM OF WORK AND DESCRIPTION Cort,No,0fDBE <br />ITEM NO. OR SERVICES TO BE AND EXPIRATION <br />SUBCONTRACTED OR MATERIALS DATE <br />0 BE PROVIDED <br />NAME OF DBEs DOLLAR AMOUNT <br />iMust be certified on the date bids DEE <br />arc opened - include DBE address <br />and phone number <br />, �n <br />2 <br />�1 *r ' <br />cd¢.�7 4-133$ 92. <br />For Local Agency to Complete: <br />Local Agency Contract Number: <br />Federal Aid Project Number: <br />Federal Share: <br />Tocol Claimed $54,1925. <br />Participation <br />I % <br />Contract Award Date: <br />Local Agency certifies that all information is complete and accurate. <br />Print Marne. Signaturo Date <br />Local Agency Representnfive <br />Aroa Code) Tele hone Number: <br />ahwoB CLQrRCI � <br />Signaturel'Didder <br />951-7310-7160 <br />Date Sif�' 1l (Area Code) Tel. No. <br />Leant Agency Ridder- DUE Infenntien (Rev 3109) <br />For Caltrans Review: <br />Print Name Signature _ Date <br />Cnitrans District Local Assistance Engineer <br />Distribution; (1) Copy —Fax or seen a copy to the Caltrans Distdel 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 de -obligation of funds for this project. <br />(2) Copy -- Include in award package to Caltrans District Local A.ssisomee <br />(3) Original — Local ngency Ines <br />. �sY <br />TO BE INCLUDED IN BID PACKAGE <br />BP 19 of 27 <br />