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Exhibit 1 5-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 /> <br />GENCY: C?i1v of Santa Ana 1_OCAIION: Jerome Park ? ?t???? `?/'If' <br />?'?? <br />' ?? <br /> <br />PROJECT llESCR1I'"PION: PROJLCI" NO. 1 2-7530 J • o P E tt -- <br />J <br />? <br />arl: F ?rlg bnn o ? t t?"Alj? ??' V'??? ?C?? <br />? <br />? <br />I"O"I"AI_ I?L-DERAL CON7"RACK AMOU N'f: $ -J 3?, l? ?j . ?? ???? !' <br />?? <br />A?iP?(y'/?+ q' <br />MIS <br />'?? <br />BID D <br />TE <br />( <br />D? <br />/? Z ?? <br />, ~?? • <br />A <br />: <br />p ! <br />Q v,y <br />BIDDER'S NAME: ?C7CG?'L- PA"VI l??1 G?QYyl P?1 <br />.ONTRAC"I' ITEM OP WORK AND DISC RIP"PION .art. No. of DBl: AMI4 OF DBls DOLLAR AMOUNT <br />ITEM NO. K SERVIC'F:S l"O BF Nll EJC PIRATION Must be certified on the date bids BE <br /> SUBCONTRACTED OR MA7"ERIA L.S DATE ? re opened -include DBE address <br /> 'O BL' PROV IDI:D rid hone number <br />? E L6L?1 - CT 3 cq- A P® 2g5-J7 ,ee <br /> 6. ? E71{?{ ? n!E-e <br /> <br /> Ls1- <br /> - Slo • 13 & <br />S- L DSCJ?-P>E - IR-¢I /I=I t o+? C 't f? IL o 8 -1 00 <br /> 8"Z ST- <br /> <br /> 3-4[0l <br />For Local Agency to Complete: <br /> Total Claimed $ 3yy 5Z3 <br />°° <br />Local Agency Contract Number P <br />rti <br />i <br />G • <br />. a <br />c <br />pa <br />on <br />Federal Aid Project Number: <br /> <br />Federal Share: ``-- <br />HCP <br /> <br />ontrac[ Award Date_ <br />Local Agency certifies that all information is complete and accu rate. /' -- P_ 9ROW48 <br />? <br /> ?? l'F.ESIDE?IT <br />I . <br />Print Name Signature Date <br />Signature of Bidder <br />Local Agency Representative 11A,11 ?I <br />11J <br />- ? ZUl2 <br />' <br /> iV <br />(JbL <br />1 59?-oi341 <br />(Area Code) Tele hone Number: <br /> <br />For Caltrans Review: <br /> Date (Area coae> Tel. No. <br />Print Name Signature Datc <br />CalCra nS District LOCaI ASSis Lance Engineer Local Agenry 6i?der- DI3E ]reformation (Rev 3/09) <br />in sin ouu on: ? ? ? ?.opy -- rax or scan a copy to ine Caltrans IJ?sln ct Local Assistance Engineer (DLA E) within 1 5 days of award. Failure [o <br />send a copy to the DI,A F: within 1 S days of award may result in de-obligation of funds for this project. <br />(2) Copy -Include in award package to Caltrans District Local Assistance <br />(3) Original -Local agency f71es <br />TO BE INCLUDED IN BID PACKAGE <br />BP 29 of 37