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: Award DBE/DBE Information 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.
Appears in 10 contracts
Samples: Master Agreement, José Consultant Agreement, Master Agreement
