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Local Assistance Procedures Manual <br />Exhibit 10-02 <br />Consultant Contract DBE Commitment <br />EX111111I' 10-02 CONSULTANT CONTRACT' OBE COMMPPMENT <br />1. Local Agency: City of Santa Ana <br />3. Project oescriptlon: Al- Environmental Site Assessment <br />4. Project Location: Various <br />5. Consultant's Name: Ninyl <br />& Moore <br />8, Total Dollar Amount for ALL Subconsultants: TBD <br />2, Contract DBE Goal: TBD <br />6. Prime Certified DBE: ❑ 7. Total Contract Award Amount: $45,219.55 <br />9. Total Number of ALL Subconsultants: TBD <br />10. Description of Work, Service, or Materials 11, DBE <br />Certification <br />12, DBE Contact information <br />13, DBE <br />Dollar <br />Supplied Number <br />Amount <br />Subconsultant 1: Drillers <br />TBD <br />Subconsultant 2: Heavy Equipment <br />TBD <br />Contractors <br />Subconsultant 3: Geophysical Surveyors <br />TBD <br />Subconsultant 4: Fixed -Base <br />TBD <br />Laboratories <br />Subconsultant 5: Mobile Laboratories <br />TBD <br />Subconsultant 6: Land Surveyors _ <br />TBD <br />Subconsultant 7: Waste Disposal <br />TBD <br />Subconsultant 8: Traffic Control <br />Local Agency to Complete this Section _ <br />... <br />$TBD <br />20. Local Agency Contract <br />Kh,mhor <br />14, TOTAL CLAIMED DBE PARTICIPATION <br />21. Federal -Aid Project Number: <br />22. Contract Execution <br />net., <br />Local Agency certifies that all DBE certifications are valid and information on <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />this form is complete and accurate. <br />regardless oftier. Written confirmation of each listed DBE is <br />required. <br />G{/1 f71� nn 8/3/2018 <br />23. Local Agency Representative's Signature 24. Date <br />16. Preparer's n r.— 16. Date <br />Anthony J. Lizzi, PG, CHG 949.753.7070 <br />25. Local Agency Representative's Name 26. Phone <br />17, Preparers 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 Assistanco Engineer (DLAE). Failure to submit to DLAE within 30 days of contract <br />execution may result In de -obligation of federal funds on contract. <br />ADA Notice: For Individuals with sensory disabilities, this document is available in alternate formals. For information call (916) 654-6410 er TDD (916) 654- <br />3880 or write Records and Forms Management, 1120 N Street, MS -89, Sacramento, CA 95814. <br />Page I of 2 <br />July 23, 20] 5 <br />