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Local Assistance Procedures Manual EXHIBIT 16-11 <br />Subcontracting Request <br />STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION FRONT <br />SUBCONTRACTING REQUEST <br />DC -CEM -1201 (REV. 4/94) (OLD FIC -45) CT# 7541-3514-7 See Instructions <br />On Back <br />REQUEST NUMBER <br />CONTRACTOR NAME <br />L' <br />2. Specialty items (previously requested)................................................................. <br />$ <br />COUNTY <br />ROUTE <br />BUSINESS ADDRESS <br />.............. <br />5. Contractor must perform with own forces ( lines 1 minus 4 x <br />CONTRACT NO. <br />CITY/STATE <br />Z[P CODE <br />FEDERAL AID PROJECT NO. (From Special <br />$ <br />S. Total (lines 6+7)................................................................................................... <br />Provisions) <br />SUBCONTRACTOR <br />(Name, Bastaess Address, Phone) <br />BID ITEM <br />NUNIBER(S) <br />% OF BID <br />ITEM <br />CHECK IF: <br />DESCRIBE WORK WHEN <br />$ AMOUNT <br />(See Categories <br />Below) <br />LESS THAN 100% OF <br />BASED ON <br />SUBBED <br />(1) <br />2 <br />3) <br />WORK IS SUBBED <br />BID $AMOUNT <br />Categories: 1) S eoialt <br />2 <br />p Y ) tsted Under Fair Practices ALt.3) Certified DBE/MBE/WBE/DVBE <br />I Certify That. <br />• The Standard Provisions for labor set forth in the contract apply to the subcontracted work. <br />• If applicable, (Federal Aid Projects only) Section 14 (Federal Requirements) of the Special Provisions have been inserted in the <br />subcontracts and shall be incorporated in any lower -tier subcontract. Written contracts have been executed for the above noted <br />subcontracted work. <br />NOTE: This section is to be completed by the Resident Engineer <br />1. Total of bid items.................................................................................................................................................$ <br />2. Specialty items (previously requested)................................................................. <br />$ <br />3. Specialty items (this request)............................................................................... <br />$ <br />4. Total (lines 2+3).................................................................................... <br />.............. <br />5. Contractor must perform with own forces ( lines 1 minus 4 x <br />% .................. ............... $ <br />6. Bid items previously subcontracted..................................................................... <br />S <br />7. Bid items subcontracted ( this request)................................................................ <br />$ <br />S. Total (lines 6+7)................................................................................................... <br />$ <br />9. Balance of work Contractor to perform (lines 1 minus 8) .................................... <br />$ $ <br />o. copy- loea i agency Labor Complinme Officer 4. Contractors lnformton Copy <br />Page 16-51 <br />February 1, 1998 <br />