Local Agency Name. Enter the name of the local or regional agency that is funding the contract.
Local Agency Name. 2. Project Location: 3. Project Description: 4. Total Contract Award Amount: $ 5. Consultant Name: 6. Contract DBE Goal %: 0.0% 7. Total Dollar Amount for all Sub-consultants: $ 8. Total Number of all Sub-consultants: 9. Description of Services to be Provided 10. DBE/DBE Firm Contact 11.DBE Cert. 12. DBE Dollar Amount Local Agency to Complete this Section 13. Total Dollars Claimed 14. Total % Claimed $ 0 0.0% % 20. Local Agency Contract Number: 21. Federal-aid Project Number: 22. Contract Execution Date: Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: 23. Local Agency Representative Name (Print) 24. Local Agency Representative Signature 25. Date 26. Local Agency Representative Title 27. (Area Code) Tel. No. 15. Preparer’s Signature 16. Preparer’s Name (Print) 17. Preparer’s Title 18. Date 19. (Area Code) Tel. No. Caltrans District Local Assistance Engineer (DLAE) certifies that this form has been reviewed for completeness: 28. DLAE Name (Print) 29. DLAE Signature 30. Date Form Name: Master City of San Xxxx Consultant Agreement Exhibit E – Disadvantaged Business Enterprise Participation Form/FileNo.: T-29972.018/ 1246116 City Attorney Approval Date: September, 2014
Local Agency Name. 2. Project Location: 3. Project Description: 4. Total Contract Award Amount: $ 5. Consultant Name: 6. Contract DBE Goal %: 0.0% 7. Total Dollar Amount for all Sub-consultants: $ 8. Total Number of all Sub-consultants: 9. Description of Services to be Provided 10. DBE/DBE Firm Contact 11.DBE Cert. 12. DBE Dollar Amount Local Agency to Complete this Section 13. Total Dollars Claimed $ 0 20. Local Agency Contract Number: 21. Federal-aid Project Number: 22. Contract Execution Date: Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: 23. Local Agency Representative Name (Print) 24. Local Agency Representative Signature 25. Date 26. Local Agency Representative Title 27. (Area Code) Tel. No.
Local Agency Name. 2. Project Location: 3. Project Description: 4. Total Contract Award Amount: $ 5. Consultant Name: 6. Contract DBE Goal %: 7. Total Dollar Amount for all Subconsultants: $ 8. Total Number of all Subconsultants:
Local Agency Name. 2. Project Location: 3. Project Description: 4. Consultant Name: 5. Contract DBE Goal %:
Local Agency Name. 2. Project Location: 3. Project Description: 4. Consultant Name: 5. Contract DBE Goal %: 6. Description of Services to be Provided 7. DBE Firm Contact Information 8. DBE Cert. Number 9. DBE % Local Agency to Complete this Section 10. Total
Local Agency Name. 2. Project Location: 3. Project Description: 4. Total Contract Award Amount: $ 5. Consultant Name: 6. Contract DBE Goal %: 0.0% 7. Total Dollar Amount for all Sub-consultants: $ 8. Total Number of all Sub-consultants: 9. Description of Services to be Provided 10. DBE/DBE Firm Contact 11.DBE Cert. 12. DBE Dollar Amount Local Agency to Complete this Section 13. Total Dollars Claimed 14. Total % Claimed $ 0 0.0% % 20. Local Agency Contract Number: 21. Federal-aid Project Number: 22. Contract Execution Date: Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: 23. Local Agency Representative Name (Print) 24. Local Agency Representative Signature 25. Date 26. Local Agency Representative Title 27. (Area Code) Tel. No. 15. Preparer’s Signature 16. Preparer’s Name (Print) 17. Preparer’s Title 18. Date 19. (Area Code) Tel. No. Caltrans District Local Assistance Engineer (DLAE) certifies that this form has been reviewed for completeness: 28. DLAE Name (Print) 29. DLAE Signature 30. Date
Local Agency Name. City of Burbank 2. Project Location: Olive Avenue at I-5 and Metrolink Tracks, Burbank, CA 3. Project Description: Olive Avenue Bridge Rehabilitation Project 4. Total Contract Award Amount: $ 168,732 for First Phase (Feasibility). Estimated $1,500,000 for total contract (TBD) 5. Consultant Name: Xxxxx Xxxxxxx Associates, Inc.
Local Agency Name. City of Burbank 2. Project Location: Olive Avenue at I-5 and Metrolink Tracks, Burbank, CA 3. Project Description: _Olive Avenue Bridge Rehabilitation Project 4.
Local Agency Name. County of Mendocino, Department of Transportation 2. Project Location: School Way (CR 236) over Russian River (M.P. 0.87) 3. Project Description: HBP Seismic Bridge Replacement on School Way at Russian River 4. Consultant Name: Xxxxxx & Associates 5. Contract DBE Goal %: 1
