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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15 -6834 <br />TRAFFIC SIGNAL MODIFICATIONS: 17Tf1 STREET AT ENGLISH STREET. <br />MACARTHUR BOULEVARD AT PLAZA DRIVE, EDINGER AVENUE <br />AT SULLIVAN STREET, WESTMINSTER AVENUE AT CLINTON STREET <br />FEDERAL PROJECT NO: HSIPL 5063(156) <br />ESIIIBrr 15 -G CONSTRUCTION COti'fRACI' DBE CON4UiTDIEINT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: 6.531 <br />Traffic Signal Modifications on: 171h St at English St, MacArthur Blvd at Plaza Dr, Edinger Ave at Sullivan, <br />3. Project Description: Westminster Ave at Clinton St <br />17'" St at English SL MacArthur Blvd at Plaza Dr, Edinger Ave at Sullivan, Westminster Ave at Clinton St <br />4. Project Location: in the City of Santa Ana <br />California Professional Engineering, Inc. Ed/ r aid e <br />5. Bidder's Name: 6. Prime Certified DBE: Amount:.. <br />8, Total Dollar Amount for ALL Subcontractors: % <br />[ �Thi 5-0 9. Total Number of ALL Subcontractors: _ <br />10. Bid <br />Item <br />q 1. Description of Work, Service, or Materials <br />12. DBE <br />Certification <br />13. DBE Contact Information <br />(Must be certified on the date bids are <br />14, DBE <br />Dollar <br />Number <br />Supplied <br />Number <br />opened) <br />Amount <br />— iq <br />�I911 M fe'ru dl, <br />u CUh + <br />h ORYIr� ' 'd%IOw <br />j{ <br />a 1rtF <br />n n <br />y1ve)Ovt lVic <br />qa -�6 O�nftNil -ANe 011tril <br />Local Agency to Complete this Section <br />S( >v )I f, I <br />P ' <br />21. Local Agency Contract Number: <br />22. Federal Project Number: <br />15. TOTAL CLAIMED DBE PARTICIPATION -1^� <br />-o{ <br />-Aid HSIPL 5063(156) <br />_ !C "U� <br />23. Bid Opening Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />24, Contract Award Date: <br />regardless of tier. Names of the First Tier DBE <br />Subcontractors and their respective ilern(s) of work listed <br />above must be consistent, where applicable with the names <br />and fternsittif the work in the "Subcontractor List" submitted, <br />Local Agency certifies that all DBE certifications are valid and information on <br />with your bl > Wxftlen ' firmation of each listed DBE is <br />this form is complete and accurate. <br />requ e I. <br />05104/2016 <br />25, Local Agency Representative's Signature 26. Date <br />_ <br />16. eparer's Siq lure '0110-1338 <br />6 $ <br />Van Nguyen <br />27. Local Agency Representative's Name 28. Phone <br />18. Preparer's Nat a 19. Phone <br />President <br />29Local Agency Representative's Title <br />20. Preparer's Title <br />DISTRIBUTION: 1 Original - Local Agency <br />2. Copy - Cailrens District Local Assistance Engineer ( DEAF). Failure to subiod to OLAE within 30 days of V.01 cl execution may resell in de- 0119ation of <br />Iederal funds on canlract. Include additional copy with award package. <br />ADA Notice: For Individuals will, sensory disabilities, this document is available In allemalo formals. F'or inlormalion call ( 916) 054 -041r TDO(916) 654J880 orw,te Records <br />and Forl Menagomenl. 1120 N Street. MS 89, SeaepOpid. OA 95814 <br />P -27 of P -40 <br />20D-42 <br />III <br />