Laserfiche WebLink
Section III: Selected MBE Subcontractors <br /> Actual%of <br /> Subcontractor Name Estimated Amount Est.%of Total Actual Amount Total Contract <br /> Contract <br /> 1 <br /> MBE Subcontractor Totals <br /> If more subcontractors are utilized,please copy N's form and attach the additional information. <br /> Section 111: Selected MBE purchase of Goods,Materials,and Equipment <br /> Actual%of <br /> Name Estimated Amount Est.%of Total Actual Amount Total Contract <br /> Contract <br /> MBE Totals <br /> If more MBE's are utilized,please copy this form and attach the additional information. <br /> CHECK ALL THAT APPLY. SPECIFIC SUPPORTING DOCUMENTATION MUST BE SUBMITTED AS INDICATED. <br /> ❑ MBE Goal of 10% has been reached <br /> ❑ MBE Goal of 10% has not been reached but Contractor has met the goal estimated on the MBE Utilization <br /> Statement submitted at Bid <br /> ❑ MBE Goal of 10% has not been reached and Contractor has not met the goal estimated on the MSE Utilization <br /> Statement submitted at Bid(attach explanation) <br /> ❑ MBE Goal of 20% has been reached and qualifies for a 2% Bonus of the final Contract Value up to a maximum of <br /> $50,000 <br /> ❑ Other—(State reason and attach explanation) <br /> The undersigned certifies that the information included herein is true and correct,failure to submit this form may result in <br /> delay of the final payment. <br /> Sionature of Prime Contractor Date <br /> 28 <br />