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<br />n <br /> <br />. <br /> <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br /> <br />275-030-11A <br />EQUAL OPPORTUNITY OFFICE <br />04/05 <br /> <br />1""1 <br /> <br />ANTICIPATED DBE PARTICIPATION STATEMENT <br /> <br />. <br /> <br />n <br /> <br />Financial Project Number: <br /> <br />. <br /> <br />Contract Number: <br /> <br />c~ OlOrc& ~ 63 .1I\,-? . r- <br /> <br />,., <br />. <br /> <br />. Federal Aid Project Number (if applicable): <br /> <br />II <br />. <br /> <br />Prime Contractor Name: <br /> <br />0wlq{+ (OY\.~^rj-H)n [0-.1 he . <br />a \{~n ( 1-D 7 ,CiJ <br /> <br />Contract Dollar Amount: <br /> <br />., <br />. <br /> <br />M <br />. <br /> <br />Is the pri~ contractor a Florida Department of Transportation Certified Disadvantaged Business Enterprise (DBE)? <br />(yes GY) (no 0) <br /> <br />Expected amount of contract dollars to be subcontracted to DBE(s): $ rj> <br /> <br />It is our intent to subcontract 4-- % of the contract dollars to DBE(s). Listed below are the proposed DBE <br />sub-contractors: <br /> <br />11 <br />. <br /> <br />DBE (s) Name <br /> <br />Tvpe of Work/Specialtv <br /> <br />Dollar AmountlPercentaqe <br /> <br />r--, <br />. <br /> <br />., <br />. <br /> <br />n <br /> <br />. <br /> <br />,., <br />. <br /> <br />., <br />. <br /> <br />Submitted by: ----.D.\LS J4 Scenc.W L <br />E-mail Address: Q;1c.'lf1. burh[c.+Cl:.VisWchcj'l .[ C. <br />Fax Number: ?:l::J!: ~,?>q7~ <br /> <br />Title: \II (a PK.suhYlf- <br />Telephone Number: ~efJ39B7B <br />Date: [012-012(1)9 <br /> <br />., <br />. <br /> <br />n <br />. <br /> <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 />n <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 />,.., <br /> <br />. <br /> <br />..., <br /> <br />. <br /> <br />February 2007 <br /> <br />00404-6 <br /> <br />03-4122.0. <br /> <br />,.... <br /> <br />. <br />