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Local Assistance Procedures Manual EX TB1T 10-01 <br />Consultant Proposal DBE Comutltment <br />ExEnBIT 10-01 CONBULTAw PROPOSAL A13E COMMI'1'Mb w <br />(Inclusive or all DBEs listed at bid proposal. Refer to Instructions an the reverse side of this form) <br />lnstrlbuthac (1) Original- Consulttau submlts to loeal agency with ptoposal <br />(2) Copy- Least Agency files <br />Page 1 of 2 <br />LPP 13-01 May 8, 2013 <br />t. <br />1. Local Agenoy Namo: 17 Y C 4-A- ma - <br />}} )&t'2 <br />2. Project Location:/f tJty�pj <br />,r� // / _� / Why <br />3. Project Description: 4Qc} ra m t'{ 0 t2 cce) t mc/L (12 ' l,Q (t 14?yL fit" Wh <br />4, Consultant Name: (2(Vf/ 9(7Urce, IAO , <br />5, Contract DBE Opal W <br />DBE Commitment Informafion <br />6. Description of Services to tie Provided 7„ DBB rami <br />contact lnrormation <br />8. DBE Cort. <br />Number <br />9. DBE % <br />Ctoo <br />ry cis <br />16,Looal Agency ContractNumber <br />17, Eedora4aid ProjectNumbar: ._.._ <br />18, Proposed Contract Execution tWo., <br />Local Agency certifles that all DBE certifications tare valid and the <br />� <br />tmt..a` MEN';vag <br />e t w r <br />11. Prepare s Signature <br />hifolmatioll on this form is complete and accurate: <br />ft (1Q✓ti <br />12, Prop ror's Nauta (Print) <br />�frnc%0 / <br />14. Local Agency Representative Namo (Plat) <br />13. Preparor`sTitle <br />24. Local Agenoy Represcatative Signature -2L pato W..� <br />� )�� Jr ��7 <br />_�_ <br />14. Date 15. (Area Code)`O"No. <br />22. Local Agency Representative Title .^ 23, (Aram Code) Tel. No.� <br />lnstrlbuthac (1) Original- Consulttau submlts to loeal agency with ptoposal <br />(2) Copy- Least Agency files <br />Page 1 of 2 <br />LPP 13-01 May 8, 2013 <br />