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Local Assistance Procedures Manual EXHIBIT 16-B <br />Subcontracting Request <br />STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION FRONT <br />SUBCONTRACTING REQUEST <br />DC -CEM -1201 (REV. 4/94) (OLD HC -45) CT# 7541-3514-7 See Instructions <br />On Buck <br />REQUEST NUMBER <br />CONTRACTOR NAME <br />COUNTY <br />ROUTE <br />BUSINESS ADDRESS <br />CONTRACT NO. <br />CITY/STATE <br />ZIP CODE <br />FEDERAL AID PROJECT NO. (Prom Special <br />Provisions) <br />SUBCONTRACTOR <br />(Name, Business Address, Phone) <br />BID ITEM <br />NUMBERS) <br />% BID <br />ITEM <br />SUBBED <br />CHECKIF: <br />(See Categories Below) <br />1 2 3) <br />DESCRIBE WORK WHEN <br />LESS THAN 100% OF <br />WORI{ISSUBBED <br />$AMOUNT <br />BASED ON <br />BID $AMOUNT <br />Categories: 1) Specialty 2) Listed Under Fair Practices Act 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 wm9c <br />CONTRACTOR'S SIGNATURE <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 />3. Specialty items (this request)............................................................................... $ <br />4. Total (lines 2+3)................................................................................................... S <br />5. Contractor must perform with own forces (lines 1 minus 4) x 0 <br />6. Bid items previously subcontracted..................................................................... S <br />7. Bid items subcontracted ( this request)................................................................ $ <br />8. Total (lines 6+7)................................................................................................... S <br />9. Balance of work Contractor to perform (lines 1 minus 8) .................................... $ <br />............................. I..... $ <br />3. Copy -local agony Labor Compliance Officer 4. Contractor's lnfom>ation Copy <br />Page 16-51 <br />February 1, 1998 <br />