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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 rabid proposal. Refer to instructions on the reverse side ofthis form) <br />S''r N rs I'` pm , ;Con ut a th Coln "lete thl� $ectlon a "bsaa z I R <br />el- <br />1. Local Agency Name: � 0_,� A1'x CT.^ (1.A. (I C, :.0Qrks Ac�('JI.0 p <br />t.�GrJ�rX. <br />2. Project Location: <br />3. Project Description: krx <br />4. Consultant Name: �.C' Cj Cu 131 �� V�r'�,C�V"C'2, �Iu + r"tutit�� <br />5. Contract DBE Goal %: <br />DBE Commitment Information <br />6. Description of Services to be Provided <br />7. DBE Firm <br />Contact Information <br />S. DBE Cart. <br />Number <br />9. DBE % <br />16. Local Agency Contract Number::',xsrfjrn <br />17. Fadarel -eid Projeot Number: <br />IS. Proposed Contract Execution Date: <br />Local Agency certifies that all DBE certifications are valid and the <br />information on this form is complete and accurate: <br />$% r <br />N 6 ' <br />11. Preparers Signatur <br />12. Preparer's Name (Print) <br />e <br />19. Local Agency Representative Name (Print) <br />20. Local Agency Representative Signature 21. Date <br />13. Preparer's Title <br />\�/ �([ <br />14. Pate X15. (Area Code) TeL No, <br />22. Local Agency Representative Title 23. (Area Code) Tel. No. <br />Distribution: (1) Original — Consultant submits to local agency with proposal <br />(2) Copy — Local Agency tiles <br />LPP 13 -01 <br />25L -184 <br />Page 1 of 2 <br />May 8, 2013 <br />