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1(3,'AjI <br />t`913 <br />CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.:15-6831 <br />CROSSWALK UPGRADES - PHASE I <br />FEDERAL PROJECT NO: HSIPL 5063(t 55) <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 sidowalk, bulb -out curb and gutter. <br />4. Project Location: Multiple Locations_fi�rj <br />5. Bidder's Name: faro Communications CoilslructfattJnc, 6, Prime Certified DBE: 137. Bid Amount: 0n �.2.�§•i ,,¢ •.. <br />8. Total Dollar Amount for ALL Subcontractors: _ 9. Total Number of ALL Subcontractors: <br />19. Bid <br />Item <br />Number <br />11. Description of Work, Service, or Materials <br />Supplied <br />12. DBE <br />Cerfification <br />Number <br />13. DBE Contact Information <br />be certified on the date bides, are opened) <br />14. DBE <br />Dollar <br />Amount <br />9 <br />�(Must <br />OLL QAq&1M1 <br />A <br />Local Agency to Complete this Section <br />y1n <br />21. Local Agency Contract Number: <br />15. TOTAL CLAIMED DBE PARTICIPATION <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 DBC Subcontractors and <br />their respective items) 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 />this form Is complete and accurate, <br />25. Local Agency Representative's Signature 26. Dateerls. <br />"Subcontractor List" submitted with your bid. Written confirmation of <br />each listed DB s required. <br />L <br />S uro 17, WIG <br />h <br />1,.` r ai <br />310.888-8040 <br />27. Local Agency Representative's Name 28. Phone18. <br />ae 19. Phone <br />epa ra <br />29. Local Agency Representative's Title <br />t< Pre wont <br />20. Preparer's Title <br />DISTRIBUTION: '1.Original -Local Agency <br />2. Copy -Caltrans District Local Assistance Eligineei (DLAB), Follow to submit to DL,AE within 30 days of contract execution lady result in de - <br />obligation of federal funds on connect. Include additional copy with award package, <br />ADA Notlee: For Individuals with sensory disabilities, this document Is available in allarnate formats. For Intonation call (916) 654-6410 or <br />TDD (916)654-3880 orwdte Records and Forms Management, 1120 N Street, MS -891 Sacramento, CA 95814. <br />P-27 of P-40 <br />r <br />