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Local Assistance Procedures Manual EXHIBIT 10 -01 <br />Consultant Proposal DBE Commitment <br />EXIIIBIT 10 -01 CONSULTANT PROPOSAL DBE COMMITMENT <br />(Inclusive of all DBEs listed at bid proposal. Refer to instructions on the reverse side of this form) <br />1. Local Agency Name: t71 dr 0&f-t—IA 604A — t/-7• 4JbL(L iWPXf -� <br />2. Project Location: ' —�t OM —. <br />3. Project Description: <br />4. Consultant Name: �tJ7l7r}(Gf� r!] <br />5. Contract DBE Goal %: <br />6. Description ofScrvices to be Provided 1 7. <br />16. Local Agency Contract Number: <br />17, Pederal•sid Project Number; <br />18. 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 />19. Laca1 Agency Representative Name (Print' <br />20. Loral Agency Representative Signature 21, Date <br />22. Local Agency Representative Titla 23. (Area Cade) Tel No <br />Distribution: (1) Original — Consultant submits to local agency with proposal <br />(2) Copy —Local Agency files <br />LPP 13 -01 <br />25L -62 <br />8, DBE Celt. <br />y%S ir <br />13 repurer's Title <br />7fK 4s !4 — ?f <br />14. Date 15.(Alm Code) Tel. No. <br />rage 1 of 2 <br />May 8, 2013 <br />