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CITY OF SANTA ANA REBID <br />PROPOSAL <br />PROJECT NO.: 17-6611 <br />CHESTNUT AVE & BUSH/CYPRESS BIKE LANES <br />FAID#: U58DP005861 <br />EXHIBIT 15-G CONSTRUCTION CONTRACT DBE COMMITMENT <br />1. Local Agency: City of Santa Ana 2. Contract DBE Goal: <br />3. Project Description: Chestnut Ave & Bush/Cypress Bike Lanes <br />4. Project Location: <br />1", and Bush St from 1"to Civic Center <br />5. Bidder's Name: V Ix slnef L bC 6. Prime Certified DBE: ❑ 7. Bid Amount: <br />8. Total Dollar Amount for for AL� tors: I �y, t/-fc%. °J 9. Total Number of ALL Subcontractors: <br />10. Bid <br />Item <br />Number <br />11. Description of Work, Service, or Materials <br />Supplied <br />12. DBE <br />Certification <br />Number <br />13. DBE Contact Information <br />(Must be certified on the date bids are opened) <br />14. DBE <br />Dollar <br />Amount <br />Local Agency to Complete this Section <br />21. Local Agency Contract Number: <br />15. TOTAL CLAIMED DBE PARTICIPATION <br />22. Federal -Aid Project Number: U58DP005861 <br />23. Bid Opening Date: March 13, 2017 <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 Subcontractors and <br />their respective item(s) of work listed above must be consistent, <br />where applicable with the names and items of the work in the <br />Local Agency certifies that all DBE certifications are valid and information on <br />"Subcontractor List" submitted with your bid. Written confirmation of <br />this form is complete and accurate. <br />each listed DBE is required. <br />`� J G/17 <br />25, Local Agency Representative's Signature 26. Date <br />16 rep er's St -nature 11/7. Date <br />18. P eparer's Name 19. Phone <br />27. Local Agency Representative's Name 28. Phone <br />29. Local Agency Representative's Title <br />20. Preparer's Title <br />DIN I x113 U 11UN: 1. Ungmal - Local Agency <br />2. Copy - Caltrans District Local Assistance Engineer (DLAE), Failure to submit to DLAE within 30 days of contract execution may Iesultin de - <br />obligation of federal funds on contract, include additional copy with award package. <br />ADA Notice: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or <br />TDD (916) 654-3880 or write Records and Farms Management, 1120 N Street, MS -89, Sacramento, CA 95814. <br />1. Local Agency: <br />2. Contract DBE Goal: P-26 of P-39 <br />