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CITY OF SANTA ANA REBID <br />PROPOSAL <br />PROJECT NO.: 17- 6611 <br />CHESTNUT AVE d BUSH/CYPRESS BIKE LANES <br />PAID#: U58DPOO5861 <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2, Contract DBE Goat: 0% <br />3. Project Description: Chestnut Ave & Bush /Cypress Bike Lanes _ <br />4. Project Location: Chestnut Ave from Cypress to Standard, Cypress Ave from Chestnut to 1 ", and Bush St hom 1 "to Civic Center Dr. _ <br />5. Bidder's Name: C r't 1 S�7of `tbi , 6. Prime Certified DBE: ❑ 7. Bid Amount: _ °j `4'D <br />8. Total Dollar Amount for ALL 5oboontraotors: Yi a g-jo- a 0 9. Total Number of ALL Subcontrectors: i <br />10. Bid <br />Item <br />11. Description of Work, Service, or Materials <br />12. DBE <br />Codification <br />13. DBE Contact Information <br />14, DBE <br />Dollar <br />Number <br />Supplied <br />Number <br />(Must be certiFled on the date bids are opened) <br />Amount <br />ii <br />i <br />_ <br />._- ....._..._ __._.. ._.....__...._....- _.- .- _...... <br />..... _ .... _ ..... _.._.- <br />- -- <br />--i <br />i <br />Local Agency to Complete this Section <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />$ <br />21. Local Agency Contract Number: v <br />— <br />22. Federal -Aid Project Number: U68DP006861 <br />/ <br />23. Bid Opening Date: March 13, 2017 <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 Subcontractors and <br />their respective Itram(s) of work listed above must be consistent, <br />whets applicable with the names and items of the work in the <br />Local Agency certifies that all DBE certifications are valid and Information on <br />"Subcontractor List" submitted with your bid. Written confirmation of <br />this form is complete and accurate, <br />each lis�tedd DBE Is required. <br />t <br />� >r1 % <br />26. Local Agency Representative's Signature 26. Date <br />s <br />16 "rep Si nature 1Z. Date <br />rep <br />re t, a (9oi)�f�-7t3c2 <br />27. Local Agency Representative's Name 28. Phone <br />187 a Name 19. Phone <br />29. Local Agency Representative's Title <br />20, Preparer's Title <br />DISTRIBUTION: 1. Original -Lunal Agency <br />2. Copy- Caltrans District Local Assistance Enitincer (I)LAEt. Failure to submit to DLAE within 30 Clays at comract cxconion may result in de- <br />obligation of federal Cards on oenbact. Include additional Copy with award paeknge. <br />ADA Notice: Far Individuals with sensory disabllliles, this document is available In alternate formats. For information Dail (916) 664 -6410 or <br />TDD (816) 654.3880 or wrlie Records and Forms Management, 1120 N Street, MS -89. Sacramento, CA 95814. <br />L Local Agency: <br />2. Contact DBE Goat: P -26 of P -39 <br />20B -36 <br />