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Section III: Selected MBE Subcontractors <br /> Est. % of Total Actual % of <br /> Subcontractor Name Estimated Amount Contract Actual Amount Total Contract <br /> ' MBE Subcontractor Totals <br /> If more subcontractors are utilized, please copy this form and attach the additional information. <br /> ' Section III: Selected MBE purchase of Goods, Materials, and Equipment <br /> Est. % of Total Actual % of <br /> Name Estimated Amount Contract Actual Amount Total Contract <br /> Agile Supply Co. 70 152.00 <br /> 12.5% <br /> r <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 /> QX 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 MBE 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 pay t. <br /> 11/15/23 <br /> onature of Prime Contractor Date <br />