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pdfGeneral Reporting
UNIFORM REPORT OF DBE COMMITMENTS/AWARDS AND PAYMENTS
**Please refer to the Instructions sheet for directions on filling out this form**
1 Submitted to (check only one):
2
[ ] FHWA
[ ] FAA
[ ] FTA‐‐Recipient ID Number
AIP Numbers (FAA Recipients); Grant
Number (FTA Recipients):
3 Federal fiscal year in which reporting period falls:
[ ] Report due June 1 (for period Oct. 1‐Mar. 31)
5 Reporting Period
6 Name and address of Recipient:
7 Annual DBE Goal(s):
4. Date This Report Submitted:
[ ] Report due Dec. 1 (for period April 1‐Sept. 30)
Race Conscious Projection
Race Neutral Projection
[ ] FAA annual report due Dec. 1
OVERALL Goal
Awards/Commitments this Reporting Period
A
AWARDS/COMMITMENTS MADE
DURING THIS REPORTING PERIOD
A
B
Total Dollars
Total Number
C
D
Total to DBEs
E
Total to DBEs
Total to DBEs
(number) /Race Conscious
(dollars)
(total contracts and subcontracts committed
during this reporting period)
(dollars)
F
G
Total to
DBEs/Race
Conscious
Total to
DBEs/Race
Neutral (dollars)
H
I
Total to
Percentage of total
DBEs/Race
dollars to DBEs
Neutral (number)
(number)
8 Prime contracts awarded this period
9 Subcontracts awarded/committed this period
10 TOTAL
B
BREAKDOWN BY ETHNICITY &
GENDER
Contracts Awarded to DBEs this Period
A
B
C
Total to DBE (dollar amount)
Women
Men
Total
D
E
F
Women
Total to DBE (number)
Men
Total
11 Black American
12 Hispanic American
13 Native American
14 Asian‐Pacific American
15 Subcontinent Asian Americans
16 Non‐Minority
17 Other
18 TOTAL
Payments Made this Period
B
A
C
PAYMENTS ON ONGOING
Number of
CONTRACTS
Ongoing Contracts
C
Total Payments Made
(report activity of ongoing contracts)
Total Number of
Contracts with
DBEs
D
E
F
Percent to DBEs
Total Number of DBE firms working
Total Payments to DBE firms
19 Prime and sub contracts currently in progress
TOTAL PAYMENTS ON CONTRACTS
COMPLETED THIS REPORTING
D
PERIOD
A
B
C
D
Number of Contracts Completed
Total Dollar Value of Contracts
Completed
DBE Participation Needed to Meet
Goal (Dollars)
Total DBE Participation (Dollars)
Percent to DBEs
20 Race Conscious
21 Race Neutral
22 Totals
23 Submitted By:
24. Signature:
25. Phone
Number:
49 CFR Part 26 Appendix B: Version 6(a)
Projectl Reporting
UNIFORM REPORT OF DBE COMMITMENTS/AWARDS AND PAYMENTS
**Please refer to the Instructions sheet for directions on filling out this form**
1 Submitted to (check only one):
2
[ ] FHWA
[ ] FAA
[ ] FTA‐‐Recipient ID Number
AIP Numbers (FAA Recipients); Grant
Number (FTA Recipients):
3 Federal fiscal year in which reporting period falls:
[ ] Report due June 1 (for period Oct. 1‐Mar. 31)
5 Reporting Period
6 Name and address of Recipient:
7 Annual DBE Goal(s):
4. Date This Report Submitted:
[ ] Report due Dec. 1 (for period April 1‐Sept. 30)
Race Conscious Projection
Race Neutral Projection
[ ] FAA annual report due Dec. 1
OVERALL Goal
Awards/Commitments this Reporting Period
A
AWARDS/COMMITMENTS MADE
DURING THIS REPORTING PERIOD
A
B
Total Dollars
Total Number
C
D
Total to DBEs
E
Total to DBEs
Total to DBEs
(number) /Race Conscious
(dollars)
(total contracts and subcontracts committed
during this reporting period)
(dollars)
F
G
Total to
DBEs/Race
Conscious
Total to
DBEs/Race
Neutral (dollars)
H
I
Total to
Percentage of total
DBEs/Race
dollars to DBEs
Neutral (number)
(number)
8 Prime contracts awarded this period
9 Subcontracts awarded/committed this period
10 TOTAL
B
BREAKDOWN BY ETHNICITY &
GENDER
Contracts Awarded to DBEs this Period
A
B
C
Total to DBE (dollar amount)
Women
Men
Total
D
E
F
Women
Total to DBE (number)
Men
Total
11 Black American
12 Hispanic American
13 Native American
14 Asian‐Pacific American
15 Subcontinent Asian Americans
16 Non‐Minority
17 Other
18 TOTAL
Payments Made this Period
B
A
C
PAYMENTS ON ONGOING
Number of
CONTRACTS
Ongoing Contracts
C
Total Payments Made
(report activity of ongoing contracts)
Total Number of
Contracts with
DBEs
D
E
F
Percent to DBEs
Total Number of DBE firms working
Total Payments to DBE firms
19 Prime and sub contracts currently in progress
TOTAL PAYMENTS ON CONTRACTS
COMPLETED THIS REPORTING
D
PERIOD
A
B
C
D
Number of Contracts Completed
Total Dollar Value of Contracts
Completed
DBE Participation Needed to Meet
Goal (Dollars)
Total DBE Participation (Dollars)
Percent to DBEs
20 Race Conscious
21 Race Neutral
22 Totals
23 Submitted By:
24. Signature:
25. Phone
Number:
49 CFR Part 26 Appendix B: Version 6(b)
| File Type | application/pdf |
| Author | timothy.mullins |
| File Modified | 2012-08-28 |
| File Created | 2012-08-28 |