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Local Assistance Procedures Manual EXHIM 10 -01 <br />Consultant Proposal DBE Commitment <br />EXIIIBIT I.0 -01 CONSULTANT PROPOSAL DBE Commff TENT <br />(Inclusive of all DDEs listed at bid proposal. Refer to instructions on the reverse side of this form) <br />Consultant to Complete this Section <br />r �a <br />1. Local Agency Name: <br />2.ProjoctLocation:_ j n _CLLArM�.. aLL <br />3. Project Description: of-- wa j GC(f aS lT ° 5`T r-f w ypr� t t�s <br />4. Consultant Nam: -(i%fa/ WI �r n- S50C,1676! .� <br />— <br />S. Contract DDE Goal %: , I- e <br />DBE Commitment Information <br />6. Description of Services to be Provided <br />7. DBE Finn <br />Contact Information <br />8. DBE Cem <br />Number <br />9. DBE% <br />Do Yo D "f <br />Local Agene t0 {'nm %etc til %3 Section <br />10.To al <br />%Clamed <br />- <br />�e <br />MFedoraWid Project Number: _., ........ . <br />I& Proposed Contract Execution Date: <br />Local Agency oortifies that all L)Blr certifications are valid and the <br />information on this form is complete and accurate: <br />11. preparer's Signature <br />12. Prepame Nnme (Print) <br />13I§epm�er's 95cia <br />14. Date _ ry I5. (Area Cade]'1'ol. No <br />19. Local Agency Representative Name (Print) <br />20. Local Agency RepresoaWtiva Signature 21. Datu� <br />22. Local Agency Represenintivo ?ids �' 23. (Area Cede) Tel. No,� <br />Distribution: (1) Original — Consultunt submits to local agency with proposal <br />(2) Copy— Local Agency files <br />Page I of 2 <br />LPP 13 -01 May 8, 2913 <br />