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COLORADO DEPARTMENT OF THAI.aPORTATION ~"1 <br />DISADVANTAGED BUSINESS ENTERPRISE ~'~^~'^-tom <br />B1D CONDITIONS ASSURANCE '-°wrQ <br />Ellca't tautly <br />IeisTRUCrlorts: <br />CONTRAGTCR - ocmptele and submit this lone whh your bid <br />POLICV -~ ~~ <br />N k the poky of the Colorado Department d Transpoltatic~n lhal disadvanlagstl hllshles5 enevprisea have mazinum <br />apporM:fly to pardepale in the pellomlanoe d eon:rack lilanced with federal, state ar Iccal entity funds <br />INTENDED~DBE PAATfCIPATIOH <br />1) W.1 ycur company's Interded DBE partldpatlon meet o~ntract WoaG? ®ya; ^ rw <br />o ,1S <br />i') Lls'. your intended DBE parlidpa'lon. _~~y 56 d D9E padlclpallon <br />9) Lls: Iha DBE IirnG ya, will use for your °ntendad DBE Padlclpal:on <br />Name 7f tirtn;s; Cenilicalion e>tp~ati;n care InW ntl.°tl Ilem(sl d work <br />Nld~ralrJO~l ntr/ ~y Sreir..!l~CE <br />Dgt- "~ ~~z~~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />I understand that, M my company Is determined to be the low bltlder for the conlad on this protect, I rnu.,~, submit a <br />coTpleted CDOT Form N715 CERTIFICATION OF DBE PARTICIPATION to the Transportation Ceparimenl b!' 4:G0 pm <br />Iha czy aY:er tha bids zrn craned. !n addilan, H m~' company does ndl meal rile imended con'racl goals I must submi a <br />wmpleted CDOT Form i~71B DBE GOOD FAITH EFFORT DOCUMENTATION before Iha above slated deadline. <br />I uneerslaM my ob lgatbn to ablda by the policy slated above. I shall not :isciminale on the basis of rata, cola r, age, <br />sac national origtrl, or hand;cap h the 616dng pratess ar the performance of contracts. <br />I DECLARE UNDER PENALTY DF PERJURY IN 7HE SECOND DEGfIFF, AIiD ANY OTHER APPLICABLE STATE <br />OR FEDERAL LAWS, THAT THE STATEMENTS MADE IN 7HI5 DOCUMENT ARE TRUE AND COMPLETE TO THE <br />BEST OF fdY KNOWLEDGE. <br />~~~'/~ere rv <br />/1QiE Pi~ridl fr ~.11115f .IQI Larpeny Qale <br />:-2-~ <br />-- -- <br />c~n4mvsrtcort rw ~/ Tie - <br />m <br />Oi <br />m <br />ml <br />m <br />1 <br />lu~ <br />D <br />~_ <br />D <br />r <br />N <br />1 <br />J <br />m <br />A <br />m <br />m <br />m <br />m <br />m <br />.- <br />a <br />~n <br />~n <br />m <br />O <br />m <br />