Local Agency Contract Number. 17. Federal-aid Project Number: 18. Proposed Contract Execution Date: 11. Preparer’s Signature Local Agency certifies that all DBE certifications are valid and the
Local Agency Contract Number. Enter the Local Agency contract number or identifier.
Local Agency Contract Number t•J-B'l'O- vf.303 18. Federal-Aid Project Number: 19.
Local Agency Contract Number. DOT AGREEMENT No. 120055 17. Federal-aid Project Number: DOT No. C-9807.03 18. Contract Execution Date: Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: Xxxxxx X. Xxxxxxxx 19. Local Agency Representative Name (Print) 20. Local Agency Representative Signature 21. Date Director of Transportation (000) 000-0000 22. Local Agency Representative Title 23. (Area Code) Tel. No. 11. Preparer’s Signature Xxxxx Xxxxxxxxxxx 00. Preparer’s Name (Print) Vice President 13. Preparer’s Title 000-000-0000 14. Date 15. (Area Code) Tel. No.
Local Agency Contract Number. DOT AGREEMENT No. 120055 21. Federal-aid Project Number: DOT No. C-9807.03 22. Contract Execution Date: Local Agency certifies that all DBE certifications are valid and the information on this form is complete and accurate: Xxxxxx X. Xxxxxxxx 23. Local Agency Representative Name (Print) 24. Local Agency Representative Signature 25. Date Director of Transportation (000) 000-0000 26. Local Agency Representative Title 27. (Area Code) Tel. No.
