8-25-26-02-20 - DVBE CONTRACTOR CLOSE OUT.pdf
PDF 115 KB Posted
- Attached to
- HODGE ELEMENTARY REFRIGERATOR
- Solicitation number
- 25-26-02-20
- Issued by
- Los Angeles County, Anaheim City, California
About this file
This is a DVBE Contractor Close-Out Statement form for the Azusa Unified School District related to the Hodge Elementary Refrigerator project in Azusa, California. The form serves as a mandatory condition for final payment and documents the participation level of Disabled Veteran Business Enterprises (DVBEs) on the contract. The statement requires contractors to report DVBE involvement across four categories of work: construction services, architecture and engineering services, procurement of materials/supplies/equipment, and information technology. Contractors must specify the dollar amount and percentage of total contract value, including change orders, that was allocated to DVBE participation.
The close-out form requires the contractor's authorized representative to certify the actual DVBE participation achieved on the project through company signature, printed name, title, and date. This documentation is essential for compliance reporting purposes and completion of the contract with Azusa USD, ensuring that disabled veteran business enterprise goals established for the project are verified and recorded prior to the contractor receiving final payment.
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Text version
DVBE Close Out Statement Azusa USD
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) CONTRACTOR
CLOSE-OUT STATEMENT
The Contractor shall complete this form, as a condition to Final Payment, for purposes of reporting participation by Disabled Veteran Business Enterprises (DVBE) in the Contract for the Project/Bid No.
specified below.
Project Name:
Bid No.:
DSA No.:
Name Address/Phone Category of Work* $ Amount of Contract
* Categories of work include: (1) construction services (specify services that DVBE will provide); (2) architecture and engineering services; (3) procurement of materials, supplies and equipment; and (4) information technology.
The undersigned, on behalf of the Contractor, certifies that DVBE participation on the Contract for Bid No.
equaled dollars ($ ), which represents approximately percent ( %) of the total Contract price including change orders for the Project.
Company:
Name:
Title:
Signature:
Date:
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