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