20110510 SWAMSubcontractingReportTemplate by hkx3mP08

VIEWS: 5 PAGES: 2

									                                                                      INSTRUCTIONS


             1.0)     Supplier SWaM Sub-contracting Monthly Report
                      Please complete the Small, Woman and Minority Owned Business (SWaM) Subcontracting Monthly Report found on the
                      BLUE tab below. The report should include all subcontracts with DMBE-certified SWaM vendors regardless of their
                      certification category. Please note that a SWaM vendor must be DMBE-certified and can be certified in multiple categories:
                      Small business, woman-owned business or minority-owned business. The report should be submitted by the 10th of each
                      month to SWAM@vita.virginia.gov.




bb2ee6ba-f2b3-4db8-985c-2480b1a689cc.xls
                                                                                                     SWaM MONTHLY SUB-CONTRACTING REPORT


COMPANY INFORMATION                                                                                                                                    REPORTING PERIOD
           Company Name:                                                                                                                                                            Month:                       Year:
     VITA Contract Number:
     Federal Tax ID Number:                                                                                                                            SUMMARY DATA (FOR VITA USE ONLY)
         Company Address:                                                                                                                                              Total Subcontracting Expenditures              $0.00
                        City:                                                      State:                     Zip:                                       Total Subcontracting Expenditures with Certified             $0.00
                                                                                                                                                                                                   MBE
                                                                                                                                                         Total Subcontracting Expenditures with Certified             $0.00
                                                                                                                                                                                                     WBE
                                                                                                                                                           Total Subcontracting Expenditures with Certified           $0.00
SUPPLIER CERTIFIES THE FOLLOWING (PLEASE CHECK BOXES):
                                                                                                                                                                                                      SBE
      Supplier certifies that it is compliant with its SWaM subcontracting plan, if applicable, for the provision of goods and services under this contract.
                                                                                                                 § 2.2-4354 of the Code of Virginia.
      Supplier certifies that it is current with payment of subcontractors, including SWaM suppliers, in accordance with


REPORT SUBMITTED BY
            Contact Person:                                                         Title:
                     Phone:                                                         Fax:
                      Email:

                                                                                                                                                                                             Federal Tax        State of      Certification     SWaM         Dollar
   Sub-contractor Name                      Address                         City             State      Zip           Phone         Contact Person                    Email                                                                                            Agency/Locality/Customer
                                                                                                                                                                                                 ID           Certification       No.         Designation   Amount




TOTAL SWaM SUB-CONTRACTING SPEND                                                                                                                                                                                                                               $0.00



        bb2ee6ba-f2b3-4db8-985c-2480b1a689cc.xls

								
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