Appendix MWBE-6 - MWBE Quarterly Compliance Report.pdf
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- Solicitation number
- 2140589
- Issued by
- New York
About this file
This document is the MWBE Quarterly Compliance Report (Form MWBE 105) issued by the New York State Department of Labor, Division of Purchase and Contracts, MWBE Administrator. The form serves as a standardized reporting mechanism for contractors and grantees to document payment compliance with certified Minority and Women-Owned Business Enterprise (MWBE) subcontractors on state contracts. Contractors are required to submit completed reports documenting the payment amounts made to NYS Certified M/WBE subcontractors during specified quarterly periods (1st Quarter: April 1–June 30; 2nd Quarter: July 1–September 30; 3rd Quarter: October 1–December 31; 4th Quarter: January 1–March 31), with failure to submit resulting in non-compliance findings. The form captures essential contract information including contractor name and federal identification number, project completion date, work location, contract type, and MBE and WBE percentage goals and dollar amounts.
The report requires detailed documentation of all M/WBE subcontractor and vendor payments, including contractor name, federal identification number, product or service code classification, work status (active, inactive, or complete), subcontractor contract amount, quarterly payments, previous payments, and cumulative payments to date. The form includes a comprehensive product code classification system spanning agricultural services, mining, construction (general, heavy, and specialty trades), manufacturing, transportation and sanitary services, wholesale and retail goods, financial and insurance services, and professional services including business services, legal services, education services, social services, and engineering and architectural services. The report is submitted to the MWBE Administrator at the Harriman State Office Campus in Albany, New York.
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Text version
MWBE 105 (01/18) Page 1 of 2
Purchase and Contracts, MWBE Administrator Harriman State Office Campus, Building 12, Room
465 Albany, NY 12226 Phone: (518) 474-2678 | Fax: (518) 457-0620
Labor.sm.MWBEAdmin@labor.ny.gov
MWBE Quarterly Compliance Report Contract 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. Submit the completed form to the address above.
Prepared By (signature): Telephone No.:
E-Mail Address: Date:
Name and Title of Preparer (print):
Failure to submit this form will result in non-compliance *See Reverse Side for Product Codes
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
Appendix MWBE-6
MWBE 105 (01/18) Page 2 of 2
Product Key Code
A = Agriculture/ Landscaping (e.g., all forms of landscaping services) B = Mining (e.g., geological investigations) C = Construction C15 = Building Construction – General Contractors C16 = Heavy Construction (e.g., highway, pipe laying) C17 = Special Trade Contractors (e.g., plumbing, heating, electrical, carpentry) D = Manufacturing E = Transportation, Communication and Sanitary Services (e.g., delivery services, warehousing, broadcasting and cable systems) F/G = Wholesale/Retail Goods (e.g. hospital supplies and equipment, food stores, computer stores, office supplies G52 = Construction Materials (e.g., lumber, paint, law supplies) H = Financial, Insurance and Real Estate Services I = Services I73 = Business Services (e.g., copying, advertising, secretarial, janitorial, rental services of equipment, computer programming, security services) I81 = Legal Services I82 = Education Services (e.g., AIDS education, automobile safety, tutoring, public speaking) I83 = Social Services (Counselors, vocational training, child care) I87 = Engineering, architectural, accounting, research, management and related services
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