Laserfiche WebLink
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 Arta 2. Contract DBE Goal: TBD <br />3. Project Description: A2 -Hazardous Material Surveys <br />4. Project Location: VadOUS <br />5. Consultant's Name: Ninyo & Moore 6. Prime Certified DBE: ID 7. Total Contract Award Amount: $1,999.09 <br />8. Total Dollar Amount for ALL Subconsultants: TBD 9. Total Number of ALL Subconsultants: TBD <br />19. Description of Work, Service, or Materials <br />Supplied <br />11. DBE <br />Certification <br />Number <br />12. DBE Contact information <br />13. DBE <br />Dollar <br />Amount <br />Subconsultant 1: IH Laboratory <br />TBD <br />��, tibal Agency ttl ComplefdLfils <br />SaeOon ',' <br />$ TBD <br />20. Local Agency Contract <br />Aum her <br />14. TOTAL CLAIMED DBE PARTICIPATION <br />TBD % <br />21. Federal-Ald Project Number. <br />22. Contract Execution <br />MIA - <br />Local Agency cenlfias that all DBE certifications are valid and Information on <br />IMPORTANT: Identify all DBE fins being claimed for credit, <br />this form Is complete and accurate. <br />regardless of tier. Written confirmation of each listed DBE Is <br />required. <br />W h91 0 8/3/2018 <br />23. Local Agency Representative's Signature 24. Date <br />1S, Preparers Biondi u 18. Date <br />Anthony J. Lizzi, PG, CHG 949.753.7070 <br />26. Local Agency Representative's Name 28. Phone <br />17. Preparees Name 18. Phone <br />Principal Geologist <br />27. Local Agency Representative's Title <br />19. 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 />executlon may result in deabligation of federal funds on contract <br />ADA Notice: For Individuals with sensory disab0111es, this document Is available In alternate formats. For Information call (916) 6548410 or TOO (916) 054 <br />3080 or write Records and Forms Management, 1120 N StreeL MS -69, Sacramento, CA 95614. <br />Page 1 of 2 <br />July 23, 2015 <br />25F-235 <br />