Attachment 1 -- M-WBE Form.pdf

This is a Minority/Women Business Enterprise (M-WBE) Participation Report form issued by the Colorado Department of Public Health and Environment, Hazardous Materials and Waste Management Division, for the Summitville WTP HDS Study project. The form is designed to track and document subcontracting activities with minority-owned businesses (MBEs) and women-owned businesses (WBEs) on a monthly basis. The report requires submission each month regardless of procurement activity during the reporting period and captures essential project identifiers including contractor name, contract number, site/project name, and the total procurement amount for the current reporting period, which should exclude amounts previously reported.

The form provides structured fields for documenting individual subcontractors, including contractor name, type of contractor, address, MBE/WBE classification status, procurement amount, and type of service provided. A section designated for internal use collects grant number information and includes fields for Disadvantaged Business Enterprise (DBE) reporting requirements for federal fiscal year compliance. The authorized representative must sign and print their name with the date of submission, ensuring accountability and accuracy of the M-WBE participation data reported.