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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 />C L NCY- Cih? of Santa Ana LOCH"f10N: Jerome Park ?" is'+/s? <br />Lr? r <br />alk .v 1 p o ? '?'' ?VU ? <br />Q <br />? <br />}' <br />P <br />I <br />I <br />7 <br />C <br />?? <br />?? <br />????c <br />1-1 ? pp <br />"'17jg <br />O I'AL FI` D <br />I?RAI' <br />CONTRACT AMOI N"f' $ <br />i? <br />H <br />Z' <br />? <br />Q ?.` <br />? ?P°(?An <br />" <br />y? <br />.' <br />BID llA7 <br />E: (Q. /O? <br />, [Z <br />,97 <br />r? <br />BIDDER'S NAME' 1?? ??? N? W„'rA? l <br />ONTIZAC'."1" ITEM 01= WORK ANU DESCRIPTION 'ert. No. of UBF_ NAME OP DBEs UOI_LAR AMOUNT <br />ITEM NO. R SER VICES 'I'O BE ND EXPIRATION Must be certit icd on the date bids DBE <br /> SUBCONTRACTED OR MA"fCRIAl_S DATE reopened -include DBE address <br /> O BE PROVIDF_D rid hone number <br />1 '?'?R+ - t-l GT 31 c IA r?? eo <br /> <br /> <br /> LA- P G.4 <br /> bz(o - SIO - <br />8- I..ikr? ¢?1 ? C $ c? _ vo <br /> 8 <br /> <br /> 7 <br />For Local Agency to Complete: <br /> Total Claimed $ 3 <br />3 <br />°° <br />` <br />/ S <br />Local Agency Contract Number P <br />i <br />i <br />i . <br />Y <br />' <br />? <br />. art <br />c <br />pat <br />on <br />Federal Aid Project Number- <br /> <br />Federal Share: /? <br />!? % <br />ontract Award Date: <br />-.-_ -____. <br />Local Agency certif5es that all information is complete and accurate. __ _ <br />/? - ? P. BREW F. <br />/ <br /> F f <br />tf ?RESID?.7? <br />Print Name SignaWre Dale Signature of Bidder <br />Local Agency Representative <br />JUN - 7 2012 <br /> <br />(Area Code) Tele hone Number: rss2) s9?-sII4? <br /> <br />For Caltrans Review: <br /> Date (Area Code) Tel. No. <br />Print Name Signature Datc <br />CalLra ns District LOCaI A5Si5tanee Eng mecr Local Agency I3iddcr- DBC In fomiatio?? (Rev 3/09) <br />u?stn bunon_ (I) Copy-Pax or scan a copy to the Caltrans District Local Assistance Engineer (DEAF') within ] 5 days of award- Fail urc to <br />send a copy to the DLAE within 1 S days of awartl may result in de-obligation of funds for This project. <br />(2) Copy -Include in award package [o Caltrans District Local Assistance <br />(3) Original -Local agency rtes <br />TO I3E INCLUDED 1N BID PACKAGE <br />BP 27 of 37