SMS.4907 Project Contract CSJ County District Letting Date

SMS.4907 Texas Department of Transportation SBE Monthly Progress Report Project: County: Letting Date: Contractor: Contract Amount: $ VENDOR NUMBER NAME OF SBE SUB/SUPPLIER *SBE DBE, HUB, DH Contract CSJ: District: For the Month of (Mo/Yr): SBE Goal: SBE Goal Dollars: $ TYPE OF WORK ________/________ % * SBE $ AMOUNT PAID FOR WORK PERFORMED THIS PERIOD AMOUNT PAID TO SBE TO DATE INCLUDE PAYMENTS TO ALL CERTIFIED SBEs, DBEs, HUBs, and DBE/HUBs. Code S=SBE, D=DBE, H=HUB, DH=BOTH IF USING A NON-SBE HAULING FIRM THAT LEASES FROM SBE TRUCK OWNER-OPERATORS, PAYMENTS MADE TO EACH OWNER-OPERATOR MUST BE REPORTED SEPARATELY. ANY CHANGES TO THE SBE COMMITMENTS, PREVIOUSLY APPROVED BY THE DEPARTMENT, MUST BE REPORTED TO THE AREA ENGINEER. FOR PROJECTS WITH ASSIGNED SBE GOALS, SUBMISSION OF THIS REPORT FOR PERIODS OF NEGATIVE SBE ACTIVITY IS REQUIRED. THIS REPORT IS REQUIRED UNTIL ALL SBE SUBCONTRACTING OR MATERIAL SUPPLY ACTIVITY IS COMPLETED. I HEREBY CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT OF THE AMOUNTS PAID TO THE SBE FIRMS LISTED ABOVE. * SIGNATURE: ________________________________________________________ COMPANY OFFICIAL __________________________ DATE THIS REPORT MUST BE SENT TO THE AREA ENGINEER’S OFFICE WITHIN 15 DAYS FOLLOWING THE END OF THE CALENDAR MONTH. 04/00

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