monthly dbe participation report...monthly dbe participation report page 2 of 2 s sc 12 rn rc 13 rn...

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MONTHLY DBE PARTICIPATION REPORT Page 1 of 2 S SC 1 RN RC 2 RN RC 3 RN RC 4 RN RC 5 RN RC 6 RN RC 7 RN RC 8 RN RC 9 RN RC 10 RN RC 11 RN RC ORIGINAL SUBCONTRACT AMOUNT PREVIOUS PAYMENTS PAYMENTS THIS REPORT TOTAL PAYMENTS TO DATE 30-Jun 31-Dec S = SUPPLIER SC = SUBCONTRACTOR APPROVED DBE VENDOR ID DESCRIPTION OF WORK DBE $ AMOUNT: 31-May 30-Nov CONTRACT $ AMOUNT: 30-Apr 31-Oct % DOLLAR COMPLETE: % PROJECT COMPLETE: 28-Feb 31-Aug DATE WORK BEGAN: DBE REQUIRED %: 31-Mar 30-Sep CONTRACT ID NO.: CONTRACTOR: NOTICE TO PROCEED: 31-Jan 31-Jul PROJECT NO.: COUNTY: REPORT NO.: REPORT SUBMISSION DATE:

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  • MONTHLY DBE PARTICIPATION REPORT

    Page 1 of 2

    S SC

    1RNRC2

    RNRC3

    RNRC4

    RNRC5

    RNRC6

    RNRC7

    RNRC8

    RNRC9

    RNRC10RNRC11RNRC

    ORIGINAL SUBCONTRACT AMOUNT

    PREVIOUS PAYMENTS PAYMENTS THIS REPORT TOTAL PAYMENTS TO DATE

    30-Jun 31-DecS = SUPPLIER SC = SUBCONTRACTOR

    APPROVED DBE VENDOR ID DESCRIPTION OF WORK

    DBE $ AMOUNT: 31-May 30-NovCONTRACT $ AMOUNT: 30-Apr 31-Oct% DOLLAR COMPLETE:

    % PROJECT COMPLETE:

    28-Feb 31-Aug

    DATE WORK BEGAN: DBE REQUIRED %: 31-Mar 30-Sep

    CONTRACT ID NO.:CONTRACTOR:

    NOTICE TO PROCEED:

    31-Jan 31-Jul

    PROJECT NO.:COUNTY: REPORT NO.:

    REPORT SUBMISSION DATE:

  • MONTHLY DBE PARTICIPATION REPORT

    Page 2 of 2

    S SC

    12RNRC13RNRC14RNRC15RNRC16RNRC17RNRC18RNRC

    PREVIOUS PAYMENTS PAYMENTS THIS REPORT TOTAL PAYMENTS TO DATE

    REPORT SUBMISSION DATE: PROJECT NO.:

    COUNTY: REPORT NO.:

    CONTRACTOR:

    RC TOTALS:

    APPROVED DBE VENDOR ID DESCRIPTION OF WORKORIGINAL SUBCONTRACT

    AMOUNT

    SIGNATURE:

    (Mandatory)

    (Mandatory)

    (Mandatory)

    THIS DOCUMENT HAS BEEN REVIEWED AT THE DISTRICT LEVEL BY:

    PRINT NAME:NAME / TITLE

    PRINT NAME:

    PRINT NAME:

    SIGNATURE:

    SIGNATURE:

    TOTAL % PAID TO DATE:

    FOR DEPARTMENT USE ONLY

    THIS DOCUMENT HAS BEEN REVIEWED AT THE PROJECT LEVEL BY:

    NAME / TITLE

    NAME / TITLE

    RN TOTALS:

    zstephensTypewritten TextI HEREBY CERTIFY THAT THE ABOVE STATEMENT IS TRUE AND CORRECT AND SUPPORTING DOCUMENTATION IS ON FILE AND IS AVAILABLE FOR INSPECTION BY DEPARTMENT PERSONNEL AT ANY TIME.

    zstephensTypewritten TextALL PARTICIPATION COUNTED TOWARD FULFILLMENT OF THE DBE GOALS IS (1) REAL AND SUBSTANTIAL; (2) ACTUALLY PERFORMED BY VIABLE, INDEPENDENT DBE OWNED FIRMS; AND (3) IN ACCORDANCE WITH THE SPIRIT OF APPLICABLE LAWS AND REGULATIONS.

    ORIGINAL

    NOTICE TO PROCEED: MONTH: OffDATE WORK BEGAN: A: C: 0B: % DOLLAR COMPLETE: % PROJECT COMPLETE: Group1: OffGroup2: OffGroup3: OffGroup4: OffGroup5: OffGroup6: OffGroup7: OffGroup8: Off6 VENDOR ID: 6 DESCRIPTION OF WORK: Group11: Off6 RN PREV PAYMTS: 6 RN PAYMTS THIS REPT: 6 RN TOTAL PAYMTS TO DATE: 0Group12: Off6 RC PREV PAYMTS: 6 RC PAYMTS THIS REPT: 6 RC TOTAL PAYMTS TO DATE: 0E: RN ORIG SUBCT TOTALS: 0RN PREV PAYMTS TOTALS: 0RN PAYMTS THIS REPT TOTALS: 0RN TOTAL PAYMTS TOTALS: 0RC ORIG SUBCT TOTALS: 0RC PREV PAYMTS TOTALS: 0RC PAYMTS THIS REPT TOTALS: 0D: 0PRINT NAME & TITLE: REPORT SUBMISSION DATE: REPORT NO: REVISED OR FINAL: 1 DBE: 1 VENDOR ID: 1 DESCRIPTION OF WORK: 1 RN PREV PAYMTS: 1 RN PAYMTS THIS REPT: 1 RN TOTAL PAYMTS TO DATE: 01 RC PREV PAYMTS: 1 RC PAYMTS THIS REPT: 1 RC TOTAL PAYMTS TO DATE: 02 DBE: 2 VENDOR ID: 2 DESCRIPTION OF WORK: 2 RN PREV PAYMTS: 2 RN PAYMTS THIS REPT: 2 RN TOTAL PAYMTS TO DATE: 02 RC PREV PAYMTS: 2 RC PAYMTS THIS REPT: 2 RC TOTAL PAYMTS TO DATE: 03 VENDOR ID: 3 DESCRIPTION OF WORK: 3 RN PREV PAYMTS: 3 RN PAYMTS THIS REPT: 3 RN TOTAL PAYMTS TO DATE: 03 RC PREV PAYMTS: 3 RC PAYMTS THIS REPT: 3 RC TOTAL PAYMTS TO DATE: 04 VENDOR ID: 4 DESCRIPTION OF WORK: 4 RN PREV PAYMTS: 4 RN PAYMTS THIS REPT: 4 RN TOTAL PAYMTS TO DATE: 04 RC PREV PAYMTS: 4 RC PAYMTS THIS REPT: 4 RC TOTAL PAYMTS TO DATE: 05 VENDOR ID: 5 DESCRIPTION OF WORK: 5 RN ORIG SUBCT AMT: 5 RN PREV PAYMTS: 5 RN PAYMTS THIS REPT: 5 RN TOTAL PAYMTS TO DATE: 05 RC ORIG SUBCT AMT: 5 RC PREV PAYMTS: 5 RC PAYMTS THIS REPT: 5 RC TOTAL PAYMTS TO DATE: 0PROJECT NO: COUNTY: CONTRACT ID NO: CONTRACTOR: 12: 13: 14: 15: 16: 18: 7 VENDOR ID: 8 VENDOR ID: 9 VENDOR ID: 10 VENDOR ID: 11 VENDOR ID: 12 VENDOR ID: 13 VENDOR ID: 14 VENDOR ID: 15 VENDOR ID: 16 VENDOR ID: 17 VENDOR ID: 18 VENDOR ID: 12 DESCRIPTION OF WORK: 13 DESCRIPTION OF WORK: 15 DESCRIPTION OF WORK: 16 DESCRIPTION OF WORK: 17 DESCRIPTION OF WORK: 18 DESCRIPTION OF WORK: Group20: OffGroup13: OffGroup14: OffGroup15: OffGroup16: OffGroup17: OffGroup18: OffGroup19: OffGroup21: OffGroup22: OffGroup9: OffGroup10: Off7 RN PREV PAYMTS: 7 RC ORIG SUBCT AMT: 8 RN ORIG SUBCT AMT: 8 RC ORIG SUBCT AMT: 9 RN ORIG SUBCT AMT: 9 RC ORIG SUBCT AMT: 10 RN ORIG SUBCT AMT: 10 RC ORIG SUBCT AMT: 11 RN ORIG SUBCT AMT: 11 RC ORIG SUBCT AMT: 7 RN PAYMTS THIS REPT: 7 RC PAYMTS THIS REPT: 8 RN PAYMTS THIS REPT: 8 RC PAYMTS THIS REPT: 9 RN PAYMTS THIS REPT: 9 RC PAYMTS THIS REPT: 10 RN PAYMTS THIS REPT: 10 RC PAYMTS THIS REPT: 7 RN TOTAL PAYMTS TO DATE: 07 RC TOTAL PAYMTS TO DATE: 08 RC TOTAL PAYMTS TO DATE: 08 RN TOTAL PAYMTS TO DATE: 09 RN TOTAL PAYMTS TO DATE: 09 RC TOTAL PAYMTS TO DATE: 010 RN TOTAL PAYMTS TO DATE: 010 RC TOTAL PAYMTS TO DATE: 011 RN TOTAL PAYMTS TO DATE: 011 RC TOTAL PAYMTS TO DATE: 011 RN PAYMTS THIS REPT: 11 RC PAYMTS THIS REPT: 11 DESCRIPTION OF WORK: 10 DESCRIPTION OF WORK: 9 DESCRIPTION OF WORK: 8 DESCRIPTION OF WORK: 7 DESCRIPTION OF WORK: 11 RC PREV PAYMTS: 11 RN PREV PAYMTS: 10 RC PREV PAYMTS: 10 RN PREV PAYMTS: 9 RC PREV PAYMTS: 9 RN PREV PAYMTS: 8 RC PREV PAYMTS: 8 RN PREV PAYMTS: 7 RC PREV PAYMTS: 6: 7: 8: 9: 10: 11: 5: 4: 3 DBE: 1 RN ORIG SUBCT AMT: 1 RC ORIG SUBCT AMT: 2 RN ORIG SUBCT AMT: 2 RC ORIG SUBCT AMT: 3 RN ORIG SUBCT AMT: 3 RC ORIG SUBCT AMT: 4 RN ORIG SUBCT AMT: 4 RC ORIG SUBCT AMT: 6 RN ORIG SUBCT AMT: 6 RC ORIG SUBCT AMT: 7 RN ORIG SUBCT AMT: Group23: OffGroup24: OffGroup25: OffGroup26: OffGroup27: OffGroup28: OffGroup29: OffGroup30: OffGroup31: OffGroup32: OffGroup33: OffGroup34: OffGroup35: OffGroup36: Off12 RN ORIG SUBCT AMT: 12 RN PREV PAYMTS: 12 RN PAYMTS THIS REPT: 12 RC PAYMTS THIS REPT: 13 RN PAYMTS THIS REPT: 13 RC PAYMTS THIS REPT: 14 RN PAYMTS THIS REPT: 14 RC PAYMTS THIS REPT: 15 RN PAYMTS THIS REPT: 15 RC PAYMTS THIS REPT: 16 RN PAYMTS THIS REPT: 16 RC PAYMTS THIS REPT: 17 RN PAYMTS THIS REPT: 17 RC PAYMTS THIS REPT: 18 RN PAYMTS THIS REPT: 18 RC PAYMTS THIS REPT: 16 RN ORIG SUBCT AMT: 15 RC ORIG SUBCT AMT: 15 RN ORIG SUBCT AMT: 14 RC ORIG SUBCT AMT: 14 RN ORIG SUBCT AMT: 13 RC ORIG SUBCT AMT: 13 RN ORIG SUBCT AMT: 12 RC PREV PAYMTS: 13 RN PREV PAYMTS: 13 RC PREV PAYMTS: 14 RN PREV PAYMTS: 18 RC ORIG SUBCT AMT: 17 RC ORIG SUBCT AMT: 17 RN ORIG SUBCT AMT: 16 RC ORIG SUBCT AMT: 18 RC PREV PAYMTS: 18 RN PREV PAYMTS: 17 RC PREV PAYMTS: 17 RN PREV PAYMTS: 16 RC PREV PAYMTS: 16 RN PREV PAYMTS: 15 RC PREV PAYMTS: 15 RN PREV PAYMTS: 14 RC PREV PAYMTS: 12 RN TOTAL PAYMTS TO DATE: 012 RC TOTAL PAYMTS TO DATE: 013 RN TOTAL PAYMTS TO DATE: 013 RC TOTAL PAYMTS TO DATE: 014 RN TOTAL PAYMTS TO DATE: 014 RC TOTAL PAYMTS TO DATE: 015 RN TOTAL PAYMTS TO DATE: 015 RC TOTAL PAYMTS TO DATE: 016 RN TOTAL PAYMTS TO DATE: 016 RC TOTAL PAYMTS TO DATE: 017: 17 RN TOTAL PAYMTS TO DATE: 017 RC TOTAL PAYMTS TO DATE: 018 RN TOTAL PAYMTS TO DATE: 018 RC TOTAL PAYMTS TO DATE: 012 RC ORIG SUBCT AMT: 18 RN ORIG SUBCT AMT: 14 DESCRIPTION OF WORK: