12 Month Contract

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12 Month Contract Powered By Docstoc
					                                                                      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 SWaM vendors regardless of their certification status.
                       Please note that a SWaM vendor is only certified in one category: 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.




14ac9f55-08ae-432e-842f-0f4abefdd2c0.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    VITA Contract
            Sub-contractor Name                       Address                          City             State       Zip           Phone                Fax         Contact Person                Email
                                                                                                                                                                                                                            ID          Certification       No.         Designation   Amount        Number




       TOTAL SWaM SUB-CONTRACTING SPEND                                                                                                                                                                                                                                                  $0.00




14ac9f55-08ae-432e-842f-0f4abefdd2c0.xls

				
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Description: 12 Month Contract document sample