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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 at bid proposal. Refer to instructions on the reverse side of this form) <br />�:�+,ansulfantµtb�CP,mPl�tttfhls.S�aGtl4�zxr�,I.�.\�?� <br />I. Local Agency Name: 1t �T 0.. � Cuvk Allvt.-. Pl l M'SJ, c- o rk s IPtC� <br />t iS <br />2. Project Location: <br />3. Project Description: a-\ — 1,.. r� a <br />_{ <br />4, Consultant Name: �i�' _t? � . 4 `i lQ (-'� t <br />1 + <br />5. Contract DBE Goal % <br />DBE Commitment Information <br />6. Description of Services to be Provided 7. DBE Firm <br />Contact Information <br />8. DBE Can. 9. DBE % <br />Number <br />16. Local Agency Contract Number: <br />17. Federal -aid Project Number': .^ ....... _...... <br />18. Proposed Contract Execution Date:„ <br />Local Agency certifies that all DUE certifications are valid and the <br />information on this form is complete and accurate: <br />.. .: - <br />11, Preparer's signator <br />N-\ 0L 6W,€LAt NCO M @04�l <br />12. Prepaon's Name (Print) <br />13. Preparer's Title <br />6 @6 1(,/ 10\ <br />74. Date i.9. (AJrea Code) Tel. No. <br />19. Local Agency Representative Name (Print) <br />20. Local Agency Representative Signature --it Date <br />22. Lxai Agency Representative Title 23. (Area Code) Tel. No. <br />Distribalan'. (1) Original— Consultant submits to local agency with proposal <br />(2) Copy—Local Agencyfilcs <br />Page 1 01'2 <br />LPP 13-01 May S, 2013 <br />