Quarterly M/WBE Utilization Data Report (UDR): (Remember to submit a completed UDR form per quarter.) CODES: Agency Name: 01- African American Male 02- African American Female Contact Name: 03- Caucasian Female 04- Hispanic (Male and Female) Contact Telephone: 05- DOT Certified African American Males and Females Reporting Period: 06- DOT Certified Caucasian Females 07- Native American (American Indians, FY: Eskimos, Aleutians and Native Hawaiians) 08- SBA Certified (All Vendors) Quarter: 09- All Others * ( Asian Pacific Americans) (ex.: 1st, 2nd, 3rd or 4th) Quarterly Total Controllable Dollars: Quarterly MBE Total Contracts Awarded Expenditures (01, 02 & to MBE 05) Quarterly WBE Total Contracts Awarded Expenditures (03 & 06) to WBE Quarterly Other Total Total Contracts Awarded Expenditures (07, 08, to Others 09*) Quarterly Hispanic Total Contracts Awarded Expenditures (04) to Hispanic Quarterly Total Total Number of (MBE, WBE and Other Contracts Awarded Expenditures) Form SMBCC Number 104A (Revised 6/16) Certified MBE (Quarterly)
Quarterly M/WBE Utilization Data Report (UDR): (Remember to submit a completed UDR form per quarter.) Agency Name: Contact Name: Contact Telephone: Reporting Period: FY: Quarter: (ex.: 1st, 2nd, 3rd or 4th) CODES: 01- African American Male 02- African American Female 03- Caucasian Female 04- Hispanic (Male and Female) 05- DOT Certified African American Males and Females 06- DOT Certified Caucasian Females 07- Native American (American Indians, Eskimos, Aleutians and Native Hawaiians) 08- SBA Certified (All Vendors) 09- All Others * ( Asian Pacific Americans) Quarterly Total Controllable Dollars: Quarterly MBE Expenditures (01, 02 & 05) Total Contracts Awarded to MBE Quarterly WBE Expenditures (03 & 06) Total Contracts Awarded to WBE Quarterly Other Total Expenditures (07, 08, 09*) Total Contracts Awarded to Others Quarterly Hispanic Expenditures (04) Total Contracts Awarded to Hispanic Quarterly Total (MBE, WBE and Other Expenditures) Total Number of Contracts Awarded Form SMBCC Number 104A (Revised 6/16) Certified MBE (Quarterly)
State_Agency_Quarterly_MBE_Report_Form.docx