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Local Assistance Procedures Manual <br />Exhibit 15-G <br />Construction Contract DBE Commitment <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: <br />3. Project Description: Fairview Street Pavement Maintenance <br />4, Project Location: Santa Ana <br />5. Bidder's Name: <br />All American Asphalt <br />8. Total Dollar Amount for ALL Subcontractors: 192,975.00 <br />6. Prime Certified DBE: ❑ <br />6% <br />7. Bid Amount: 1,389,297 <br />9. Total Number of ALL Subcontractors: 3 <br />10, Bid <br />Item <br />Number <br />11. Description of Work, Service, or Materials <br />Supplied <br />12. DBE <br />Certification <br />Number <br />13. DBE Contact Information <br />(Must be certified on the date bids are opened) <br />14. DBE <br />Dollar <br />Amount <br />5 <br />Crackseal <br />31176 <br />Global Road Sealing, 714-893-0845 <br />55,500 <br />10,12,13 <br />No 6 pull box and loops <br />31176 <br />Global Road Sealing, 714-893-0845 <br />26,000 <br />3 <br />Supply A/C oil <br />10447 <br />E.M. Oil Transport, Inc. (323)722-9088 <br />34,135.68 <br />Local Agency to Complete this Section <br />$ 115,635.68 <br />21. Local Agency Contract Number: <br />22. Federal -Aid Project Number: <br />75. TOTAL CLAIMED DBE PARTICIPATION <br />23. Bid Opening Date: <br />8.3 % <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 Items) of work listed above must be consistent, <br />Local Agency certifies that all DBE certifications are valid and Information on <br />this form Is complete and accurate. <br />where applicable with the names and items of the work in the <br />contractor List" submitted with your bid, Written confirmation of <br />ac listed USE is required. <br />"m /t-`< 8/23/17 <br />25. Local Agency Representative's Signature 26. Date <br />1 reparer's Signature 17. Dale <br />Brines McGee 951-736-7600 <br />27. Local Agency Representative's Name 28. Phone <br />18. Preparer's Name 19, Phone <br />Project Manager <br />29. Local Agency Representative's Title <br />20. Preparer's Title <br />DISTRIBUTION: 1. Original — Local Agency <br />2. Copy — Caltrans District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days of contract <br />execution may result in de -obligation of federal funds on contract. Include additional copy with award package. <br />ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6416 or TDD (916) 654- <br />3886 or write Records and Forms Management, 1126 N Street, MS -89, Sacramento, CA 95814. <br />Page 1 of 2 <br />July 23,2015 <br />