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Exhibit 15-G2 Local Agency Bidder DBE Information (Construction Contracts) <br />(Inclusive of all DBEs including the UDBEs listed at bid proposal) <br />NOTE: PLEASE REFER TO INSTRUCTIONS ON APPENDIX F <br />? !•l?e Q' <br />GENCY: City of Santa Ana I <br />OCA"I-ION: >erome Park ?' <br />. <br />1w <br />? <br />- <br />' <br />PROJEC <br />1 <br />UESCRIP"ZION: PROIE-C"F NO. 12-75271 P' k Sect ? 1 ? I t' 1 nn n e t?''-'?V(j ?LA? <br />C?F?uf °??'/l?/(?• ?„ <br />? <br />?Mp? <br />OTAL. PEDIRA1. CON"I'KA CL AMOUNT: $ _? H??? I 13 ? __ ?? <br />BID DATE: [¢ ?O[¢?[Z <br />BIDDER'S NAME: GX C.-cl? P?V[/y? ?tl• ?• 1 ?1 <br />ONTRACI' I"I'EM OP WORK AND DESCRIPTION ert. No. of DBE NAMG OI' DBEs DOLLAR AMOUNT <br />ITEM NO. R SERV ICES "f0 BG ND EXPIRA"PION Mus[ be certified on the date bids DBE <br /> 'UBCO NTRACTGD OR MATEI2IA LS 1>A"I74 re opened -include DBE address <br /> ?O BE PROVIDED nd hone number <br />__- 1 - _ _ _.__ ? ?J1L?? FOPd? plant-ESS - o <br /> L C 't? ?,s <br /> <br /> 1 <br /> <br /> <br />- Fr tk..i -7 6° <br /> taus <br /> rll M q- G.4 <br /> <br /> i <br />For Local Agency to Complete: <br /> "Total Claimed ? <br />$3yy?3 <br />Local A <br />enc <br />Contract Number P <br />i <br />i <br />i _ <br />g <br />y art <br />c <br />pat <br />on <br />Federal Aid Project Number <br /> <br />Federal Share: , LL,,__ <br />TAP % <br />ontract Award Dale: <br />Local Agency cerG Pies that all information is complete and accurate. - ++ ? ? ????? <br /> <br /> <br />Print Name Signature Date Signature of Bidder <br />Local Agency Representative <br />(Area Code) Tele hone N <br />b .IUR - 7 2012 css21 ss?-sIIas <br />um <br />er_ <br />For Caltrans Review: <br />Date (Area Code) Tel_ No_ <br />Print Name Signature llate <br />Caltran9 Dislri Cl Local Ass is Ca nee Engineer Local Agency J3idder-DBE Inform anon (Rev 3/09) <br />U is[n but?on: (1) Copy -Fax or scan a copy w the Caltrans District Local AssisLa nee Engineer (DEAF) within 15 days of award. Failure to <br />send a copy to the ULA L' within 1 5 days of award may result in de-obligation of funds for this proj ect_ <br />(2) Copy -- Include in award package to Caltrans Districx Local Ass islance <br />(3) Original -Local agency (Sles <br /> <br />TO BE INCLUDED IN BID PACKAGE <br />BP 23 of 37