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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6834 <br />TRAFFIC SIGNAL MODIFICATIONS: I7Tll 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 />EXHIBIT t S -G CON91'11I1C"1'ION CONTRACT DBE CommITMIENT <br />1. Local Agency: City of Santa Ana 2, Contract DBE Goal: 6.63 <br />Traffic Signal Modifications on: 17" 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 St, 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.7. Bid 2 --7 <br />5. Bidder's Name: 6. PI !me Certified DBE: l/ Amount: �U� t r�� <br />8. Total Dollar Amount for ALL Subcontractors.ig (R%7417 50 9, Total Number of ALL Subcontractors: <br />10. Bid <br />Item <br />11, Description of Work, Service, or Materials <br />12. DBE <br />Certification <br />13. DBE Contact Information <br />(Must be certified on the dale bids are <br />14, DBE <br />Dollar <br />Numbet(rrh <br />Supplied <br />Number <br />opened) <br />Amount <br />31,CLIA`{ <br />1615'rrltc6l�n r� <br />"JI��-% <br />Vyou Gi. <br />� (�y"� . <br />cAcdt <br />� ✓6eQ.�I�! IriC <br />/ <br />Local Agency to Complete this Soction <br />$ 7? <br />21. Local Agency Contract Number: <br />15. TOTAL CLAIMED DBE PARTICIPATION _I^� <br />22. Federal -Aid Project Number: HSIPL 5063(156) <br />!h' q <br />23. Bid Opening Date: <br />24. Contract Award Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />regardless of tier, Names of the First Tier DBE <br />T <br />Subcontractors and their respective item(s) of work listed <br />above must be consistent, where applicable with the names <br />anditem f the work in he "Subcontractor List" submitted <br />Local Agency certifies that all DBE certifications are valid and information on <br />with your to ,Xti4tten firmation of each Ilsted DBE is <br />this form is complete and accurate. <br />requ 'ed <br />05/04/2010 <br />25. Local Agency Representative's Signature 26. Date <br />16. pfepai Sig lure 16�2�a10-1338 <br />Van Nguyen <br />27. Local Aqency Representative's Name 28. Phone <br />18. Preparer's Nat ie 19. Phone <br />President <br />29. Local Agency Representative's Title <br />20, Preparer's Title <br />DISTRIBUTION'. 1. Ongims - Lnaal Agency <br />2. Copy - Caltrans District Local Assistance Engineer ml-Ae. Failure to submit to DLAE within 30 days of contract execution may result In de -obligation of <br />federal fund: on conlracl. Include addde al copy with award package. <br />ADA Noticw Forwd,viduels with sensory disabilities, this document is available lnaitematelarmais. For information call (916)850.6410 or TDD(916)654-3660 orwite Records <br />and Fomts Management 1120 N Street. MS69. Sacramento, CA 95ai4. <br />P-27 d P-40 <br />v15b <br />