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Local Assistance Procedures Manual Exhibit 10-02 <br />Consultant Contract DBE Commitment <br />EXHIBIT 10-02 CONSULTANT CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: TBD per Task Order <br />3. Project Description: Various Environmental Services - Environmental Site Assessments (Al) <br />4. Project Location: City of Santa Ana <br />5. Consultant's Name: KMFA 6. Prime Certified DBE: ❑ 7. Total Contract Award Amount: $149,850 <br />8. Total Dollar Amount for ALL Subconsultants: $12,000 9. Total Number of ALL Subconsultents: <br />10. Description of Work, Service, or Materials <br />Supplied <br />11. DBE <br />Certification <br />Number <br />U. DBE Contact Information <br />13. DBE <br />Dollar <br />Amount <br />Professional Land Survey Services34096 <br />a surveys,Inc <br />Kelvin Kitaoka <br />53,750 <br />President- LS 6178 <br />114U Io. uarry Avenue <br />Suite #110 <br />Santa Ana, California 92705 <br />Niel lo 0 949:6M80 16 <br />Fax # 949-660-1758 <br />Email Address - KelvinK@Kelsurveys.com <br />...Local Agency til �omPlete tbls Segtipn <br />$ 3,750 <br />20. Local Agency Contract <br />nr"ml.w- <br />14. TOTAL CLAIMED OBE PARTICIPATION <br />2'5 q <br />21. Federal -Aid Project Number. <br />22. Contract Execution <br />flafa• <br />Local Agency certifies that a0 DBE cerlificallons are valid and Information on <br />IMPORTANT: Identify, all DBE firms being claimed for credit, <br />this form is complete and accurate. <br />regardless of der. Written confirmation of each listed DBE is <br />required. <br />AAa.G/ -�— 7/23118 <br />23. Local Agency Representative's Signature 24. Date <br />15. Preparers Signature 16. Date <br />R,C. Forrest III (914) 589-3095 <br />25. Local Agency Representative's Name 28. Phone <br />17. Preparers Name 16. Phone <br />President <br />27. Local Agency Representative's Title <br />19. Preparers Titie <br />DISTRIBUTION: 1. Original - Local Agency <br />2. Copy- Caltrans District Local Assistance Engineer (DLAE). Failure to submit to OLAE within 30 days of contract <br />execution may result In de -obligation of federal funds on contract <br />ADANotice: For Individuals with sensory disabilities, 80s document Is avallable In alternate formats. For infonnadon call (816) 654-6410 or TOD (016) 654- <br />3880 <br />543880 orwdte Records and Fortes Management, 1120 N Street, MS -89, Sacramento, CA 95814. <br />Page 1 of 2 <br />July 23, 2015 <br />25F-165 <br />