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Local Assistance Procedures Manual EXI11f1IT 10.01 <br />Consultant Pro osill OBE Coffimltment <br />EXULOITIO -01 CONSULTANT ftOPOSALDHECOMMITMENT <br />(inclusive, of all DBEs listed at bid proposal. Referto lnstruetions on the reverse side of this form) <br />S 6 s e n <br />. a 'rr4Ffi''Y, <re`r <br />P a. <br />P�'t� <br />-8 <br />1. Leant Ag<alcy Namno.. l�.l++ G7i- C# rP `o_ T€� 4 t <br />��tt <br />2. Project Location: %7` li / /{h - - <br />3. project Dascsiptlon:4i (' t?2 Q 12ft tMt ?'. <br />/� <br />4, Consu €tantName:. (2; ytt <br />6, Contract DBE Coat %:—Az— <br />DUE Commltmont Information <br />6. Despriptlon offloolces to be Provided 7. DBE Finn & DBE Can. 9. DBE % <br />Co lactLtformati Number <br />1rrKG <br />– <br />I`V <br />F3 '4+b <br />�s- c"'- "'6, *ocfll eneyttb �GR711P� @I}. 1�§, e�4$vtt',n,�1.,t <br />16, Local Al ancy ContrautNumber. <br />17, Padetai•rdd ProjxF Nunebar.,W <br />18. Proluxed Caatraat Execution Date. <br />Local Agency certifies that all DBE certifications are valid and the <br />lnfomation on this form Is comptote and accurate: <br />19, Local Agency Representative Name (Pilot) • <br />2e. Local Alt enoY Representative Signamm 31. Dale <br />11, Loral Agency Rapresanlutive Tltlo 13, (Area Code) Tel. No. <br />u <br />a a <br />� Van� <br />Axf ,54Ei� <br />�y , <br />rSs_Y`L: <br />ti. Propora ssignamre <br />Il _lam i <br />11 Prep is Name (Print) <br />?Cie glmnI <br />13. Prepflrot's TIt�T- <br />�FSF- i7 ,7. <br />14. Dole 13. (Arco Coda) Tal. No, <br />lllstribanon: (t) Original– Cansnitarn submits to laanlaganoyivith Proposal <br />(3) Copy –Loam Agency files <br />Page 10172 <br />LPP 13.01 May 8, 2013 <br />25L -282 <br />