STATE WATER RESOURCES CONTROL BOARD DIVISION OF FINANCIAL ASSISTANCE – DISADVANTAGED BUSINESS (DBE) UTILIZATION CLEAN REVOLVING FUND FINANCING AGREEMENT 1. Grant/Finance Agreement Number: 2. Semi-Annual Reporting Period: 3. Purchase Period of Financing 04/01/ through 09/30/ Agreement: C-06- Start Date:______________ 10/01/ through 03/31/ Ending Date:____________ 4. Total Payments Paid to Prime Contractor or Sub-Contractors This Period: $ 5. Recipient’s Name and Address: 6. Recipient’s Contact Person and Phone Number: 7. List All DBE Payments Paid by Prime Contractor and/or Recipient During Reporting Period: Payment or Amount Paid to Any DBE Date of Product Type Name and Address of DBE Contractor or Purchase Paid by Contractor/Sub-Contractor For Payment Code ** Sub-contractor or Vendor Recipient or Service Provided to Recipient (M/D/Y) (see below) Contractor? MBE - WBE 8. Initial here if no DBE Contractors/Sub-Contractors paid during this reporting period. (______) 9. Initial here if all purchases for this contract are completed. (______) 10. Comments: 11. Signature and Title of Recipient’s Authorized Representative 12. Date: Return to: **Product Type: 1: Construction State Water Resources Control Board 2. Supplies Division of Financial Assistance 3. Services (Includes Business P. O. Box 944212 Services, Professional Services, Sacramento, CA 942444-2120 Repair Services, and Personnel Services) 4. Equipment Fax: (916) 327-7469 UR-334 Revised May 2012 STATE WATER RESOURCES CONTROL BOARD - DIVISION OF FINANCIAL ASSISTANCE DISADVANTAGED BUSINESS (DBE) UTILIZATION CLEAN REVOLVING FUND FINANCING AGREEMENT
STATE WATER RESOURCES CONTROL BOARD – DIVISION OF FINANCIAL ASSISTANCE DISADVANTAGED BUSINESS (DBE) UTILIZATION CLEAN REVOLVING FUND FINANCING AGREEMENT 1. Grant/Finance Agreement Number: C-06- 2. Semi-Annual Reporting Period: 04/01/ through 09/30/ 10/01/ through 03/31/ 3. Purchase Period of Financing Agreement: Start Date:______________ Ending Date:____________ 4. Total Payments Paid to Prime Contractor or Sub-Contractors This Period: $ 5. Recipient’s Name and Address: 6. Recipient’s Contact Person and Phone Number: 7. List All DBE Payments Paid by Prime Contractor and/or Recipient During Reporting Period: Payment or Purchase Paid by Recipient or Contractor? Amount Paid to Any DBE Contractor/Sub-Contractor For Service Provided to Recipient MBE - WBE Date of Payment (M/D/Y) Product Type Code ** (see below) Name and Address of DBE Contractor or Sub-contractor or Vendor 8. Initial here if no DBE Contractors/Sub-Contractors paid during this reporting period. (______) 9. Initial here if all purchases for this contract are completed. (______) 10. Comments: 11. Signature and Title of Recipient’s Authorized Representative 12. Date: Return to: **Product Type: 1: Construction State Water Resources Control Board 2. Supplies Division of Financial Assistance 3. Services (Includes Business P. O. Box 944212 Services, Professional Services, Sacramento, CA 942444-2120 Repair Services, and Personnel Services) 4. Equipment Fax: (916) 327-7469 UR-334 Revised May 2012 STATE WATER RESOURCES CONTROL BOARD - DIVISION OF FINANCIAL ASSISTANCE DISADVANTAGED BUSINESS (DBE) UTILIZATION CLEAN REVOLVING FUND FINANCING AGREEMENT