I Exhibit - MWBE Contractor Compliance and Payment Quarterly Report of NYS AGENCY Contract No. ___________________ Project No. _____________________ The following information indicates the payment amounts made by the grantee/contractor to the NYS Certified M/WBE subcontractor on this project. The payments as shown made are in compliance with contract documents for the above referenced project. Contractors Name and Address Federal ID# Goals/$ Amt. Contract Type ___________________________ MBE ____%= __________ Paid to Contractor This Quarter_____________ WBE____%=___________ Total Paid to Contractor To Date ____________ Project Completion Work Location Reporting Period: Date ___ 1st Quarter (4/1-6/30) ____ 3rd Quarter (10/1-12/31) ___ 2nd Quarter (7/1-9/30) ____ 4th Quarter (1/1-3/31) M/WBE Product Work Status Total Subcontractor Payments this Quarter Previous Payments Total Payment Made to Subcontractor/Vendor Code* This Report Contract Amount Date MBE WBE MBE WBE MBE WBE MBE WBE Name: ___Active FED ID# ___Inactive ___Complete Name: ___Active FED ID# ___Inactive ___Complete Name: ___Active FED ID# ___Inactive ___Complete Name: ___Active FED ID# ___Inactive ___Complete Total *See Reverse Side for Product Date_________ Name________________________ Title ____________________ Signature______________________
Exhibit I - MWBE Contractor Compliance and Payment Quarterly Report of NYS AGENCY Contract No. ___________________ Project No. _____________________ The following information indicates the payment amounts made by the grantee/contractor to the NYS Certified M/WBE subcontractor on this project. Contractors Name and Address Federal ID# Goals/$ Amt. MBE ____%= __________ WBE____%=___________ Contract Type ___________________________ Paid to Contractor This Quarter_____________ Total Paid to Contractor To Date ____________ Project Completion Date Work Location Reporting Period: ___ 1st Quarter (4/1-6/30) ____ 3rd Quarter (10/1-12/31) ___ 2nd Quarter (7/1-9/30) ____ 4th Quarter (1/1-3/31) M/WBE Subcontractor/Vendor Product Code* Work Status This Report Total Subcontractor Contract Amount Payments this Quarter Previous Payments Total Payment Made to Date MBE WBE MBE WBE MBE WBE MBE WBE Name: FED ID# ___Active ___Inactive ___Complete Name: FED ID# ___Active ___Inactive ___Complete Name: FED ID# ___Active ___Inactive ___Complete Name: FED ID# ___Active ___Inactive ___Complete Total The payments as shown made are in compliance with contract documents for the above referenced project. *See Reverse Side for Product Date_________ Name________________________ Title ____________________ Signature______________________
18-102%20Exhibits%20Final%204-24-18.docx