CALIFORNIA PROFESSIONAL ENGINEERING, INC. (7)

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CITY OF SANTA ANA PROPOSAL PROJECT NO.: 15-6834 TRAFFIC SIGNAL MODIFICATIONS: 17 T STREET AT ENGLISH STREET, MACARTHUR BOULEVARD AT PLAZA DRIVE, EDINGER AVENUE AT SULLIVAN STREET, WESTMINSTER AVENUE AT CLINTON STREET FEDERAL PROJECT NO: HSIPL 5063(156) INSTRUCTIONS — CONSTRUCTION CONTRACT DBE COMMITMENT CONTRACTOR SECTION 1. Locnl Agency - Enter the name of the ]coal or regional agency that is funding the contract. 2. Contract DBE Goal - Enter the contract DBE goal percentage as it appears on the project advertisement. 3. Project Location - Enter the project location as it appears on the project advertisement, 4. Project Description - Enter the project description as it appears on the project advertisement (Bridge Rehab, Seismic Rehab, Overlay, Widening, etc). - 5. Bidder's Name - Enter the contractor's firm name. 6. Prime Certified DBE - Check box if prime contractor Is a certified DBE. 7. Bid Amount - Enter the total contract bid dollar amount for the prime contractor. 8. Total Dollar Amount for ALL Subcontractors —Enter the total dollar amount for all subcontracted contractors. SUM = (DBEs + all Non - DBEs). Do not include the prinne contractor information in this count. 9. Total number of AA L subcontractors — Enter tite total number of all subcontracted contractors, SUM = (DBEs+ all Non -DBEs). Do not include the prime contractor information in this count. 10. Bid Item Number - Enter bid item number for work, services, or materials supplied to be provided. 11. Description of Work, Services, or Materials Supplied - Enter description of work, services, or materials to be provided. Indicate all work to be performed by DBEs Including work performed by the prime contractor's own forces, if the prime is a DBE. If 100% of the item is not to be performed or furnished by the DBE, describe the exact portion to be performed or furnished by hire DBE. See LAW Chapter 9 to determine how to count the participation of DBE firms. 12. DBE Certification Number- Enter the DBE's Certification Identification Number, All DBEs must be certified on the date bids are opened. 13. DBE Contact information - Enter the name, address, and phone number of all DBE subcontracted contractors. Also, enter :he prime con'tractor's name and phone number, ifthe prime is n,DBE. 14. DBE Dollar Amount - Enter the subcontracted dollar amount of the work to be performed or service to be provided. Include the prime contractor if the prime is a DBE. See LAPM Chapter 9 for how to count full/partial participation. 15. Total Claimed DBE Participation - $: Enter the total dollar amounts entered in the "DBE Dollar Amount" column. %: Enter the total DDE participation claimed ("'Total Claimed DBE Participation Dollars" divided by iter "Bid Amotmt"). Ifthe total "/. claimed is less than item "Contract DBE Goal," an adequately documanted Good Faith Effort (GF,PJ is required (see Exhibit 15-H DBE Inibrmation - Good Faith Efforts of the LAPNI). - 16, Preparer's Signature - The person completing the DBE comntittnent'form on behalf of the contractor's firm must sign their name. 17. Date - Enter the date the DBE, commitment form is signed by the contractor's proparcr. 18. Preparer'.s Name - Enter the name ofthe person preparing and signing the contractor's DBE commionord form, 19. ,Phone - Enter the •urea code and pliers number ofthe person signing the contractor's DBE commitment form. 20, Preparer's Title - Enter the posiflon/title of the person signing the contractor's DBE eommitruent form, LOCAL AGENCY SECTIC)N 21. Local Agency Contract Number - Enter the Local Agency contract number or identiver. - 22. Federal -Aid Project Number - Enter the Federal -Aid ProjectNmnber. 23. ,Bid Opening Date - Enter the dote contract bids were opened. 24. Contract Award Date- Enter the date the contract was executed. 25, Local Agency Representative's Signature - The person completing this section of tlro form for the Local Agency must sign their came to certify that the information in this and the Contractor Section of this form is complete and aromatic. 26. Date - Enter the date the DBE commitment form is signed by the Local Agency Representative. 27. Local Agency Representative's Name - Enter the name of the Local Agency Representative certifying the contractor's DBE commitment form. 28. Phone -Enter the area code and phone comber of dw person signing the contractor's DBE commitment form. - - 29. Local Agency Representative Title -Enter the position/titlo of the Local Agency Representative certifying the contractor's DBE conuniament form, P-28 of P-40