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If3,4i1 <br />it 913 <br />CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 15-6831 <br />CROSSWALK UPGRADES - PHASE I <br />FEDERAL PROJECT NO: HSIPL 5063(155) <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: _ City of Santa Ana 2. Contract DBE Goal: 3.57 <br />3. Project Description: Installation of rapid rectangular flashing beacons signage, striping, sidewalk bulb -out curb and gutter. <br />4. Project Location: Multiple Locations <br />5. Bidder's Name: A/faro Communications Constructiondr c. 6. Prime Certified DBE: ❑ 7. Bid Amount: ' 222 ®J0+ <br />8. Total Dollar Amount for ALL Subcontractors: 9. Total Number of ALL Subcontractors: <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 />)ISM <br />r <br />Ytcral vd.o ,itala <br />V2_% <br />G$ C Cy�rAC4 C , <br />�{ t o0 <br />a'f't <br />G)O-fin.0.t CAR6IM-1 <br />Local Agency to Complete this Section <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />$��r®®l1• <br />21. Local Agency Contract Number: <br />22. Federal -Aid Project Number: HSIPL 5063 (155) <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 Subcontractors and <br />their respective item(s) of work listed above must be consistent, <br />where 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 />25. Local Agency Representative's Signature 26. Date <br />each listed DS 's required. J �✓ <br />^ er's S' ure 17. to <br />t"` Y <br />27. Local Agency Representative's Name 28. Phone <br />310.669-8949 <br />18. B epay y, ame 19. Phone <br />29. Local Agency Representative's Title <br />V. President <br />20. Preparer's Title <br />uro uunu uvrv: r. vrigmar -Locm Agency <br />2. Copy- Caltrans District Local Assistance Engineer (DLAE), Failure to submit to DLAE within 30 days of contract execution may result in de - <br />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) 654-6410 or <br />TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS -89, Sacramento, CA 95814. <br />P-27 of P-40 <br />0 <br />