Laserfiche WebLink
Local Assistance Procedures Manual <br />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. 10% <br />3. Project Description: Materials Testing and Inspection Services (MTIS) <br />4. Project Location: City of Santa Ana (Citywide) <br />5. Consultant's Name: RMA Group 6. Prime Certified DBE: ❑ 7. Total Contract Award Amount NTE $950,00( <br />8. Total DollarAmount forte Subconsuhants: $950,000.00 9. Total Number of ALL Subconsuhants: <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 />Additional MTIS Services <br />37594 <br />California Testing & Inspection <br />Fabiola, PE - 213-748-4900 <br />950.000 <br />Local Agency to Complete this Section <br />$950,000. <br />20. Local Agency Contract <br />Nmmhpr <br />14. TOTAL CLAIMED DBE PARTICIPATION <br />21. Federal -Aid Project Number: <br />22. Contract Execution <br />10 % <br />nate <br />Local Agency certifies that all DBE certifications are valid and information on <br />IMPORTANT: Identify all DBE fines being claimed for credit, <br />this forth is complete and accurate. <br />regardless of tier. Written confirmation of each listed DBE is <br />required. n <br />01/27/2023 <br />23. Local Agency Represemative's Signature 24. Date <br />15. Preparers Signature 16. Date <br />Slawek Dyrnerski, PE, GE 909-989-1751 <br />25. Local Agency Representative's Name 26. Phone <br />17. Preparers Name 18. Phone <br />Vice President <br />27. Local Agency Representative's Title <br />19. Preparers Title <br />DISTRIBUTION: 1. Original — Local Agency <br />2. Copy— Cahrans 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 disabilities, this document is available in alternate formats. For Information call (916) 654-5410 or TDD (916) 854- <br />3880 orwnte Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. <br />Page 1 of 2 <br />July 23,2015 <br />