Laserfiche WebLink
Local Assistance Procedures Manual <br />Exhibit Il <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 (At) <br />4, Project Location: City of Santa Ana <br />5, Consultant's Name: KMFA 6. Prime Certified DBE: 0 7. Total Contract Award Amount: $149,850 <br />S. Total Dollar Amount for ALL Subconsultants: $12.OM 9. Total Number of ALL Subconsultants: 7 <br />10, 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 />Professional Land Survey Services <br />34096 <br />Kelvin Kftaokac <br />$3,750 <br />President - LS 0178 <br />Avenue <br />Suite #110 <br />Santa Ana, California 92705 <br />Fax # 949-660-1758 <br />Email Address - KetvinK@Kelsurveys.com <br />Loral Agency to Complete this Section . <br />$ 3,750 <br />20. Local Agency Contract <br />AI„mhAr <br />14. TOTAL CLAIMED DBE PARTICIPATION <br />21. Federal -Aid Project Number: <br />22, Contract Execution <br />2.5 <br />nata <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 of tier. Written confirmation of each listed DBE is <br />required. <br />7/23118 <br />23, Local Agency Representative's Signature 24. Date <br />15, Preparers Signature 16. Date <br />R.C. Forrest 111 (914) 589-3095 <br />26. Local Agency Representative's Name 26. Phone <br />17. Preparer's Name 18. Phone <br />President <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 />execution may result in de -obligation of federal funds on contract. <br />ADA Notice: For individuals with sensory dlsabllitles, this document Is available in alternate formats. For Information call (916) 654-6410 or TOO (916) 654- <br />3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 96814. <br />Page I of 2 <br />July 23,2015 <br />