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Sample Business Contract - Excel

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Sample Business Contract document sample

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									REFERENCE THIS SAMPLE 1 ONLY IF YOU HAVE SWaM SUBCONTRACTORS OR SUBCONSULTANTS TO REPORT, OTHERWISE REFERENCE SAMPLE 2
                            LISTING OF UTILIZATION OF DISADVANTAGED BUSINESSES BY GENERAL CONTRACTOR OR PROFESSIONAL FIRM

                        SAMPLE                                      SAMPLE                                                SAMPLE
FIRM INFORMATION:                                                                                                                                                                    Firm
            Firm Name: ABC Contractors                                                                        Date Form Completed: 3/28/2008                                         Type
        Contact Person: Sally Sue
        Phone Number: 555-234-5678
                                                                                       Quarter: January 1, 2008 - March 31, 2008
PROJECT INFORMATION:                                                                                                      .




                                                                                                                                                                                                   Minority-Owned Business
                                                                                                                                                                                                                             Woman-Owned Business
                Agency: 207/209/246 (circle one)                University of Virginia                                                      Agency Reference:
                Project: T.J. Hall                                                                                                          207--Academic
            Sub-Project: Electrical (IF APPLICABLE)                                                                                         209--Health System
                                                                                                                                            246--UVA Wise




                                                                                                                                                                                  Small Business
                                                                                            DPOR                              Services or                             … or % of
                                                                     Contact Person/   Registration # (if   DMBE               Materials    Amount on Contract this     Total
        Firm Name                      Firm Address                  Phone Number        applicable)      Certificate #        Provided            Quarter            Contract
Alpha Omega Engineers   521 Sunset Blvd., Baltimore, MD 26327    John Doek/262- 2700000000               10101            Engineering                      $15,000       15.0%                                               x
                                                                 543-9625
Simpson's Paper Mart    624 King Way, Forest, CA 36954           Jane Doel/212-  2710000000              20202            Office Supplies                   $2,500         2.5% x
                                                                 458-2613
Quality Contractors     333 Mockingbird Lane, Fluvanna, VA 23967 Sally Doem/617- 2720000000              68954            Demolition                       $45,000       45.0%                     x
                                                                 427-3649




Notes: DPOR and        http://www.dpor.state.va.us/regulantlookup/selection_input.cfm?CFID=2344425&CFTOKEN=10413291
DMBE numbers can be
found at the following http://www.dmbe.state.va.us/cgi-bin/search.cgi
websites:
REFERENCE THIS SAMPLE ONLY IF YOU HAVE NO SWaM SUBCONTRACTORS OR SUBCONSULTANTS TO REPORT, OTHERWISE USE SAMPLE 1
                           LISTING OF UTILIZATION OF DISADVANTAGED BUSINESSES BY GENERAL CONTRACTOR OR PROFESSIONAL FIRM

                         SAMPLE                          SAMPLE                                                SAMPLE
FIRM INFORMATION:                                                                                                                                                   Firm
            Firm Name: ABC Contractors                                                             Date Form Completed: 3/28/2008                                   Type
        Contact Person: Sally Sue
        Phone Number: 555-234-5678
                                                                            Quarter: January 1, 2008 - March 31, 2008
PROJECT INFORMATION:                                                                                           .




                                                                                                                                                                                  Minority-Owned Business
                                                                                                                                                                                                            Woman-Owned Business
              Agency: 207/209/246 (circle one)       University of Virginia                                                      Agency Reference:
              Project: T.J. Hall                                                                                                 207--Academic
          Sub-Project: Electrical (IF APPLICABLE)                                                                                209--Health System
                                                                                                                                 246--UVA Wise




                                                                                                                                                                 Small Business
                                                                                                                                                         … or
                                                                                 DPOR                              Services or                           % of
                                                          Contact Person/   Registration # (if   DMBE               Materials    Amount on Contract this Total
      Firm Name                      Firm Address         Phone Number        applicable)      Certificate #        Provided            Quarter          Contr



No subcontractors used
this quarter.

								
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