Laserfiche WebLink
<br />-- <br /> <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br /> <br />275-030-11A <br />EQUAL OPPORTUNITY OFFICE <br />04/05 <br /> <br />ANTICIPATED DBE PARTICIPATION STATEMENT <br /> <br />I <br /> <br />I 1 <br />I <br /> <br />Financial Project Number: <br /> <br />Contract Number: <br /> <br />OJ -0<1- -0 \ <br /> <br />Federal Aid Project Number (if applicable): <br /> <br />Prime Contractor Name: ~~ bY- <br />Contract Dollar Amount: <br /> <br />~ ') -=\-N' L <br /> <br />Is the prime contractor a Florida Department of Transportation Certified Disadvantaged Business Enterprise (DB E)? <br />(yes 0 ) (no ~) <br /> <br />Expected amount of contract dollars to be subcontracted to DBE(s): $ '\ St OOv <br /> <br />It is our intent to subcontract ~ % of the contract dollars to DBE(s). Listed below are the proposed DBE <br />sub-contractors: <br /> <br />DBE (s) Name Type of Work/Specialty <br />~~~U t ~.~') 11,^,^\(\,,",~ "CA:Y \'"'1') <br /> <br />Dollar Amount/Percentaoe <br /> <br />100/0 <br /> <br />I <br />II <br />I <br />I <br />I~ <br /> <br />---~ <br />SUbmitted0 . -::~ """"Q FM-~-'ritle: r Ile'b I~ <br /> <br />E-mail Address: ~M\.IIJ Qtt,K?(eM-c!f~rl~6\. c-'\ Telephone Number: <br /> <br />Fax Num~f (Jb tf) 7 r q( - ~ toO Date: / p;' /~/d' i <br />F~ )( '. ~ sy 7 'b'b - oc:>o <;. <br />Note: This information is used to track and report anticipated DBE participation in all state and federally funded FOOT <br />contracts. The anticipated OBE amount will not become a part of the contractual terms. <br /> <br />This form must be submitted at the pre-construction or pre-work conference. DOT staff must forward this to the <br />Equal Opportu nity Office, 605 Suwannee Street, MS 65 Tallahassee, FL 32399-0450 or fax to (850) 414-4879. If <br />you have any questions, please contact the EOO at (850) 414-4747. <br /> <br />I I <br />I <br />II <br /> <br />February 2007 <br /> <br />00404-6 <br /> <br />03-4122.0. <br />