HomeMy WebLinkAboutExhibit 10-O2 5-29-2014_MdLocal Assistance Procedures Manual EXHIBIT 10-02
Consultant Contract DBE Information
EXHIBIT 10-02 CONSULTANT CONTRACT DBE INFORMATION
(Inclusive of all DBEs listed at contract award. Refer to instructions on the reverse side of this form)
Consultant to Complete this Section
I. Local Agency Name: City of La Quinta
2. Project Location: Dune Palms Road over the Coachella Valley Stormwater Channel
3. Project Description: Replacement of a Low Water Crossing with a new all-weather Bridge
4. Total Contract Award Amount: $
5. Consultant Name: Bengal Engineering
6. Contract DBE Goal %: 1.0%
7. Total Dollar Amount for all Subconsultants: $
8. Total Number of all Subconsultants: 5
Award DBE/DBE Information
9. Description of Services to be Provided
10. DBE/DBE Finn
Contact Information
It. DBE Cert,
Number
12. DBE Dollar
Amount
Bride Engineer
Md Wahiduzzaman
31261
$ 739,140
H drolo and Hydraulics
250 Big Sur Drive
Geotechnical Engineering
Goleta, CA 93117
Civil Engineering
Mana ement of Pro'ect Tasks
Local Agency to Complete this Section
13. Total
Dollars
Claimed
739,140
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:
14. Total
%Claimed
o
63.0 /o
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
Md. Wahiduzzaman
16. Preparer's Name (Print)
CEO, Principal
Caltrans to Complete this Section
Caltrans District Local Assistance Engineer (DLAE) certifies that this form
has been reviewed for completeness:
28. DLAE Name (Print) 29. DLAE Signature 30. Date
17. Preparer's Title
5/29114 805-563-0788 x101
18. Date 19. (Area Code) Tel. No,
Distribution: (1) Copy -Email a copy to the Caltrans District Local Assistance Engineer (DLAE) within 30 days of contract award. Failure to send a
copy to the DLAE within 30 days ofcontract award may result in delay ofpayment.
(2) Copy - Include in award package sent to Caltmns DLAE
(3) Original- Local agency files
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LPP 13-01 May 8, 2013