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Local Assistance Procedures 11(anual NXHMIT 10 -01 <br />Consultant Proposal DBE Cornlnitouent <br />EX MIT10 -01 CONST7I JTANT PROPOSAL DBE COMMITMENT <br />(Inclusive of s.11Ms listed stbidpmposal Refer to instructions on the reverse side of this form) <br />r; i Y+S'Sai r iir..e "ki <br />ON <br />Na <br />1 Loci Agency Name: City of Santa ^a, Ptt}aI'C wnrks De ari @nt <br />2, Project Locations TBD Santa Ana <br />3 Proja'.Desxlpflon•TBD Demolition <br />4 ConsultentNane J &G industries, Inc. <br />5. Contred D9EGos W 11 . $2 <br />DBE Commitment Information <br />6 Derrrlptlondr�vloe;tobe Provides <br />7. DBE Firm <br />Gontsd Informatl on <br />Number <br />9. DBE% <br />Asbestos Abatemnt <br />Tri Span Inc <br />26203 <br />DD <br />Truckin' Services <br />G.O. RodricTmez Truckina <br />39690 <br />TBD <br />n Tynv /Enq <br />�^ P <br />16, Local Agency Contract Number• <br />17 Fedear -aid Pmja:t Nurrbw, <br />Is proposed Contruat Execution Data,' <br />Local Agoracy certifies that all D:BB certifications are valid and the <br />trAermadon on this fbrm is complete and accurate: <br />Sara s Slgu e <br />J mes K. Cain <br />12; Preparers Nama(Print) <br />President. <br />19. LoeA Agency Repre antative Name (Pri nt) <br />2e. local Agenay i2apeesentetiveSpgnature 21. Duto <br />Z2 Looal Agoucy Representative Title -1(A Code) Tel. No. <br />13. Preparers Tntle <br />71a_ana 2802- <br />14 Date 15. (Arc -a Ccde)Yd Na <br />Distdbudoa- (T)Oieb.'>a7.— Consultant submits folocel agency with proposal <br />(2) Copy —Local Agency files <br />Page 1 of 2 <br />