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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT N0, 14-6799: New Traffic Signal on Newhope St and Camille St <br />PROJLCT NO. 14.6800: Traffic Signal Modification on Segerstrom Ave and Bear St <br />it Emil l'r 15-C CONSTRUC'11ON CONTRACT DBE ConrntzTx4uNr <br />1. Local Agency: _ Cffy of Santo Ana 2. Contract DBE Goal: 1.06% <br />3. Project Description: Traffic signal modificaflon on aeaerstrom Avenue at Bear Rtraet <br />4. Project Location: Ganarstrnm Avenue at Rear Street In the City of Santa Ana <br />5. Bidder's Name: PIM General Engineering SVCS Inc.8. Prime Certified DBE: ❑ <br />7. aid <br />Amount: 158172.00 <br />8. Total Dollar Amount for ALL Subcontractors: 38975.00 9. Total Number of ALL Subcontractors: <br />10. Bid <br />Item <br />11. Description of Work, Service, or Materials <br />12, DBE <br />13. DBE Contact Information <br />14. DBE <br />Supplied <br />Certification <br />(Must be certified on the date bids are <br />Dollar <br />Number <br />Number <br />opened) <br />Amount <br />Pin. #37Traffic <br />Loops Crackfiling Inc. <br />& 38 <br />Portion of loop install. <br />38033 <br />946 S. Emerald St. Anaheim, CA 92804 <br />5455.00 <br />714.520.4026 <br />Local Agctncy to Co tipicte-this See(wn _ <br />$ 5455.00 <br />21, Local Agency Contract Number: <br />22, Federal -Aid Project Number: <br />18, TOTAL CLAIMED DBE PARTICIPATION 3.4 <br />HSIPL 5063(l 51) <br />23. aid Opening Date; October 8, 2015 <br />24. Contract Award Date: <br />IMPORTANT: Identify all DBE firms being claimed for credit, <br />regardless of tier. Names of the First Tier DBE <br />Subcontractors and their respective Rem(s) of work listed <br />above must be consistent, where applicable with the names <br />and Items oft work in the "Subcontractor list" submitted <br />Local Agency dangles that all DBE certifications are valid and ➢nformation on <br />with your bid. dtten confirmation of each listed DBE is <br />this form is complete and accurate. <br />rodoir <br />10.07.2015 <br />25. Local Agency Representative's Signature 26. Date <br />18. Pr p er,$ Signature 17. Date <br />EIizak),Qth H Mendoza de MSRae 951 710 1000 <br />27. Local Agency Representative's Name 28, Phone <br />18. Preparer's Name 19, Phone <br />President/CFO <br />29. Local Agency Representative's Title <br />20. Pre arer's Tide <br />DISTRIBUTION: 1. Original -Lo cal Agency <br />2. Copy - collages District Local Assistance Engineer (DLAE). Failure to submit to DLAE within 30 days <br />of contract execution may result in de -obligation of federal funds on contract. Include additional copy <br />with award package. <br />ADA Notice: For individuals with sensory disablliges, this document Is available In alternate formats, For Information call (g16) $54.6410 <br />or TDD (916) 664-3880 or write Records and Forme Management, 1120 N Street, MS -89, Sacramento, CA 95614. <br />mm <br />