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SBE _ DBE MonthlyFinal Utilization Report

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					(check one) Professional Services Construction Other

(check one) DBE SBE NSG

(check one) Monthly Final Page 1 of

Santa Clara Valley Transportation Authority
Small/Disadvantaged Business Enterprises (S/DBE's) Utilization Report
Firm (Prime) : Contract Title: Contract Number: Report Period: 0 Address: City, State, Zip Code Phone No:

NAME AND TITLE OF PERSON COMPLETING THIS FORM (PLEASE PRINT OR TYPE)

Signature: a. Amount of Contract Completed: b. TOTAL Amount of Contract (Including all change orders): c. % of Contract Completed: d. S/DBE Contractor Committed Goal (use approved Bid Form): e. S/DBE Amount: (% x Total Contract) = f. S/DBE Work Paid to Date: g. S/DBE % of Contract Completed: h. % of S/DBE Goal Completed : $ $ $ Form Completion Date:

#DIV/0! 0
0.00 #DIV/0! #DIV/0! When Contract progress is 50% or more complete and if S/DBE % of goal complete (h) is less than the total % of the contract completed, Contractor must submit a report to VTA on how it will achieve S/DBE contract goal by completion of contract.

Advertised Contract Goal

0.00%

THIS FORM IS NOT TO BE ALTERED IN ANY WAY. ALTERED FORMS WILL BE REJECTED AS NONCOMPLIANT.
*SBE/DBE must be certified or accepted as certified by the Santa Clara Valley Transportation Authority
OSDB - Jan 2008

Page 2 of

Santa Clara Valley Transportation Authority
Small/Disadvantaged Business Enterprises (S/DBE's) Utilization Report

Materials/Supplies/Trucking Item Number(s) or General Description of work performed this period (electrical, landscape, engineering, survey, etc.)

Current Contract:

List all S/DBE* Contractors/Suppliers/Tru ckers

Paid this period 100%

Adjust to 60% or Broker Fee (which ever is applicable)

Paid Previously

Paid this period

Paid to date (I)

Paid Previously

Paid this Period

Paid to Date (II)

Total Paid to date (III)

Add New Line

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

THIS FORM IS NOT TO BE ALTERED IN ANY WAY. ALTERED FORMS WILL BE REJECTED AS NONCOMPLIANT.
*S/DBE must be certified or accepted as certified by the Santa Clara Valley Transportation Authority
OSDB - Jan 2008

INSTRUCTIONS FOR COMPLETING THE MONTHLY UTILIZATION REPORT

a. This is the total amount of money paid to date by VTA for work completed on this contract. b. This is the current Contract amount, including all executed change orders and amendments. Please refer to the Contract Total shown on your most recent Progress Payment Report. c. (a ÷ b = c) d. Use the DBE/SBE % listed on the approved Bid Form #4. If you do not have a copy of the approved Bid Form #4 please request a copy from the Resident Inspector/Resident Engineer/Project Manager (RI/RE/PM) for this contract. e. (b x d = e) f. Total of Column III g. (f ÷ a = g) h. (f ÷ e = h) Column I - Total amount (paid to date) of Materials/Supplies/Trucking allowed to count toward DBE/SBE goal. Supplies are counted @ 60% of the value. Only Broker fees can be counted for DBE/SBE Truck Brokers (see below). RI/RE/PM must verify these amounts. Column II - Total Contract work paid to date to DBE/SBE's Column III = Column I plus Column II. This total goes on line f. CREDIT FOR DBE/SBE VENDOR of materials or supplies is limited to 60% of Contractor's expenditures for materials and supplies required under this Contract and obtained from a DBE/SBE regular dealer (supplier). Credit for DBE/SBE manufacturers is given at 100% toward the DBE/SBE goal only where the DBE/SBE vendor manufactures or substaintially alters the material prior to resale. CREDIT FOR DBE/SBE BROKERS (Distributor or Representative) is limited to the fees and commissions of the amount paid. All other firms receive 100% credit, less work subcontracted by the DBE/SBE to non-DBE/SBE firms, toward the DBE/SBE goal. Materials used in the normal course of work may be counted. CREDIT FOR DBE/SBE TRUCKING FIRMS is limited to amount performed by the DBE's/SBE's own trucks and drivers and by certified DBE/SBE trucking subhaulers, plus fees and commissions on brokered trucks and trailers. A DBE/SBE trucking firm must itself own and operate at least one fully licensed, insured and operational truck used on the contract. A DBE/SBE must be certified or accepted as certified by VTA. For DBE regulations refer to 49CFR Part 26. THIS FORM IS DUE MONTHLY, ONE WEEK FOLLOWING THE END OF THE MONTH. THE FINAL DBE/SBE UTILIZATION FORM IS DUE PRIOR TO FINAL PAYMENT. NSG CONTRACTS ONLY: Reports are due immediately following the first payment, in April for the six month period ending March 31st, in October for the six month period ending September 30th and at 100% completion your final report is due. Construction Contractors: Please contact the Resident Inspector/Resident Engineer if you need assistance completing this form correctly. Professional Services: Please contact the Office of Small and Disadvantaged Businesses if you need assistance completing this form correctly.


				
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posted:11/15/2009
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