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<br />.., <br /> <br />. <br /> <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br /> <br />275-030-11A <br />EQUAL OPPORTUNITY OFFICE <br />04/05 <br /> <br />...., <br /> <br />ANTICIPATED DBE PARTICIPATION STATEMENT <br /> <br />. <br /> <br />,.... <br /> <br />. <br /> <br />Financial Project Number: <br /> <br />Contract Number: <br /> <br />OJ -oct -() \ <br /> <br />,.., <br /> <br />. Federal Aid Project Number (if applicable): <br /> <br />.., <br />. <br /> <br />Prime Contractor Name: ~~ 6Y- <br /> <br />e~ ') ~N"L <br /> <br />Contract Oollar Amount: <br /> <br />.., <br /> <br />. <br /> <br />. <br /> <br />Is the prime contractor a Florida Oepartment of Transportation Certified Oisadvantaged Business Enterprise (OBE)? <br />(yes 0 ) (no ~) <br /> <br />Expected amount of contract dollars to be subcontracted to OBE(s): $ "-\ S to 00 <br /> <br />It is our intent to subcontract ~ % of the contract dollars to OBE(s). Listed below are the proposed OBE <br />sub-contractors: <br /> <br />II <br /> <br />., <br />. <br /> <br />OBE (s) Name <br /> <br />Type of Work/Specialty <br /> <br />Dollar AmountlPercentaqe <br /> <br />.., <br />. <br /> <br />S\-r..~J t ~.~~ l,,^-^\C \"':J <br /> <br />T,..,A:\r ~~) <br /> <br />loG /0 <br /> <br />.., <br />. <br /> <br />II <br /> <br />. <br /> <br />,.., <br />. <br /> <br />. <br /> <br />~ <br /> <br />SUbmittedCj. ~ \1,....,0 F;...v'<"'l::.ritle: r ([e'b I O~ <br /> <br />E-mail Address: ""'~IA&I J Q +CK~ e.it\-~ ~r 1~6\. (....-"\ Telephone Number: <br /> <br />Fax Num~f. (Jb J,() 71 i - ~ too Oate:,/ ~/~/d.j <br />Ff\-)( '. ~ sy 7 ~'b - 0<90 <; <br />Note: This information is used to track and report anticipated OBE 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 />.... <br /> <br />II <br /> <br />. <br /> <br />,., <br /> <br />:~ <br /> <br />. <br /> <br />This form must be submitted at the pre-construction or pre-work conference. DOT staff must forward this to the <br />Equal Opportunity 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 />M <br />. <br /> <br />.., <br />I <br />. <br /> <br />February 2007 <br /> <br />00404-6 <br /> <br />03-4122.0. <br /> <br />r-, <br />. <br />