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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 ON APPENDIX F <br />AGENCY: LOCATION: <br />PROJECT DESCRIPTION: PROJECT NO. 13-679T Maple Bike Trail Safety Enhancements Occidental Street St Andrew Place <br />St. Gertrude Place CM -5063(149 <br />TOTAL FEDERAL CONTRACT AMOUNT: $ 261.322 <br />BID DATE: SFI — 9 Ng11 <br />"t <br />BIDDER'S NAME: ° ' <br />CONTRACT <br />ITEM OF WORK AND DESCRIPTION Cert.No.ofDBE <br />NAME OF DBEs DOLLAR AMOUNT <br />ITEM NO. <br />OR SERVICES TO BE AND EXPIRATION <br />(Must be certified on the date bids DBE <br />SUBCONTRACTED OR MATERIALS DATE <br />are opened - include DBE address <br />O BE PROVIDED <br />and phone number <br />i <br />3 <br />'11M�o <br />t <br />PWAIN <br />Ao213 Tlhtioid <br />VD) 6 Z0,1 <br />w 2 <br />M0 rYl1 <br />I u M QPL 'L <br />For Local Agency to Complete: <br />S j <br />Total Claimed $ 6v <br />&— <br />Local Agency Contract Number <br />Participation —L `^' <br />Federal Aid Project Number. <br />Federal Share <br />0/0 <br />Contract Award Date: <br />Local Agency certifies that all information is complete and accurate. <br />�q��' r✓t�✓" <br />Signature of Bidder P. WN, PRESI EN <br />Print Name Signature Date <br />Local Agency Representative <br />Area Code Tele hone Number <br />— X914 gJ6i) "a99�5B4! <br />dl d <br />Date (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—Pax or scan acopy to the Caltrans District Local Assistance Engineer(DLAE) 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 />BP 18 of 26 <br />