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Local Assistance Procedures Manual EXHIBIT 16 -B <br />Subcontracting Request <br />STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION FRONT <br />SUBCONTRACTING REQUEST <br />DC -CEM -1201 (REV. 4/94) (OLD HC -45) CT# 7541- 3514 -7 See Instructions <br />On Back <br />REQUEST NUMBER <br />CONTRACTOR NAME <br />COUNTY <br />ROUTE <br />BUSINESS ADDRESS <br />CONTRACT NO. <br />CITY /STATE <br />ZIP CODE <br />FEDERAL AID PROJECT NO. (From Special <br />Provisions) <br />SUBCONTRACTOR <br />(Name, Business Address, Phone) <br />BID ITEM <br />NUMBER(S) <br />% BID <br />ITEM <br />SUBBED <br />CRECKIF: <br />(See Categories Below) <br />(1) (2) (3) <br />DESCRIBE WORK WHEN <br />LESS THAN 100% OF <br />WORK IS SUBBED <br />$AMOUNT <br />BASED ON <br />BID$AMOUNT <br />Categories: 1) Specialty 2) Listed Under Fair Practices Act 3) Certified DBE /MBE /WBE /DVBE <br />I Certify That: <br />• The Standard Provisions for labor set forth in the contract apply to the subcontracted work. <br />• If applicable, (Federal Aid Projects only) Section 14 (Federal Requirements) of the Special Provisions have been inserted in the <br />subcontracts and shall be incorporated in any lower -tier subcontract. Written contracts have been executed for the above noted <br />subcontracted work. <br />uarr; <br />NOTE: This section is to be completed by the Resident Engineer <br />1. Total of bid items .................................................................................................................. ............................... $ <br />2. Specialty items (previously requested) .................................. ............................... $ <br />3. Specialty items (this request) ................................................ ............................... $ <br />4. Total (lines 2+ 3) .................................................................... ............................... $ <br />5. Contractor must perform with own forces (lines 1 minus 4) x % ........... ............................... I$ <br />6. Bid items previously subcontracted ................................ .. <br />...... ............................. $ <br />7. Bid items subcontracted ( this request) ................................. ..4............................ $ <br />8. Total (lines 6+ 7) .................................................................... ............................... $ <br />9. Balance of work Contractor to perform (lines I minus 8) ..... ..........4.................... $ $ <br />' APPROVED <br />ENGENEER'S SIGNATURE <br />�crv�- rwi(te, -9n nnv.+o'p WFY UlsimUUllUN: 1. ungmal- Contractor 2. copy -local agency Resebot Engineer <br />3. Copy - local agency Labor Compliance Officer 4. Contractor's lnrornlatlon Copy <br />Page 16 -51 <br />23A -53 February 1, 1998 <br />