Attachment K-6 - Sample ACDBE Monthly Participation Report.pdf
PDF 830 KB Posted
- Solicitation number
- 240757
- Issued by
- Wayne County, Detroit City, Michigan
About this file
The document is a Wayne County Airport Authority (WCAA) ACDBE Concessionaire Monthly Participation Report, designed to monitor Airport Disadvantaged Business Enterprise (ACDBE) participation in airport concessions. The report is required to be submitted monthly during the term of the Concession Agreement, in accordance with 49 CFR 23, to track ACDBE participation dollars and compliance with contractual commitment percentages. The form is to be completed for each separate contract held with the Airport Authority, listing each concept, ACDBE participant, activities performed, revenue received, and joint venture participation.
The report requires detailed documentation including total gross revenue, ACDBE name, participation/commercially useful function, ACDBE gross revenue, joint venture percentage of gross sales, and ACDBE participation dollars. Submission is mandatory by the 15th of each month to business.diversity@wcaa.us, with strict requirements for certification and signature. The form includes sections for prime concessionaire information, operating performance details, and ACDBE joint venture participants, emphasizing transparency and accountability in tracking minority business enterprise involvement at Detroit Metro and Willow Run airports.
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Text version
Instructions:
Operating Performance Information:
A B C D E F G H I = D x H J
Location &Terminal
Concept Name Concession Type
Total Gross Revenue (Dollars)
ACDBE Name ACDBE Participation/Commercially Useful Function (goods & services provided this reporting period)
ACDBE Gross Revenue (Actual Dollars Received)
ACDBE J/V % of Gross Sales
ACDBE J/V
Participation
(Dollars)
ACDBE Certification of Participation Amounts
(Signature & Date)
Total ACDBE Payments
Total ACDBE Participation $
Wayne County Airport Authority ACDBE Concessionaire Monthly Participation Report
Company Name:
On-Site Manager:
Total Gross Revenue
ACDBE Joint Venture Participants ONLY
Mailing Address:
Telephone Number:
Fax Number:
E-Mail Address:
In accordance with 49 CFR 23 the Wayne County Airport Authority requires this report to be submitted monthly during the Term of the Concession Agreement. This report is used to monitor ACDBE participation dollars and compliance with the contractual ACDBE contract commitment percentage.
1. Complete one report for each separate contract held with the Airport Authority.
- List each concept and respective ACDBE participant, along with the activities performed(attach additional pages if necessary , revenue received, and J/V participation (if applicable)
- Ensure certifications are completed by each ACDBE participant and an official responsible for the Prime Concessionaire's financial records.
- Signatures are necessary to certify that the reported values are complete and accurate to the best of the signatory's knowledge (Pictures of signatures will NOT be accepted)
- ACDBE firms must sign on each line in which their participation is reported.
2. Submit report to the Airport Authority on or before the fifteenth (15th) day of each month to business.diversity@wcaa.us.
Prime Concessionaire Information:
Joint Venture? YES NO
The undersigned representative of the Prime Concessionaire has reviewed the information submitted on this statement and confirms that it is true, correct and complete.
Printed Name Title Signature/Date WCAA ACDBE Monthly Participation Report - Revised 11/8/2017
WAYNE COUNTY AIRPORT AUTHORITY ATTACHMENT
Monthly Operating Statement
| Company Name: |
| OnSite Manager: |
| Mailing Address: |
| Telephone Number: |
| Fax Number: |
| EMail Address: |
| Total Gross Revenue: 0 |
| Total ACDBE Payments: 0 |
| Total ACDBE Participation: 0 |
| Group1: Off |
| Location TerminalRow1: |
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| Concept NameRow1: |
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| ACDBE NameRow1: |
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| ACDBE ParticipationCommercially Useful Function goods services provided this reporting periodRow1: |
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| ACDBE Gross Revenue Actual Dollars ReceivedRow1: |
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| ACDBE JV Participation DollarsRow1: |
| 0: 0 |
| 1: 0 |
| 2: 0 |
| 3: 0 |
| 4: 0 |
| ACDBE NameRow2: |
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| ACDBE ParticipationCommercially Useful Function goods services provided this reporting periodRow2: |
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| ACDBE Gross Revenue Actual Dollars ReceivedRow2: |
| 0: |
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| ACDBE JV Participation DollarsRow2: |
| 0: 0 |
| 1: 0 |
| 2: 0 |
| 3: 0 |
| 4: 0 |
| ACDBE NameRow3: |
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| ACDBE ParticipationCommercially Useful Function goods services provided this reporting periodRow3: |
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| ACDBE Gross Revenue Actual Dollars ReceivedRow3: |
| 0: |
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| ACDBE JV Participation DollarsRow3: |
| 0: 0 |
| 1: 0 |
| 2: 0 |
| 3: 0 |
| 4: 0 |
| Text2: |
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| Signature2: |
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| Dropdown3: |
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| Dropdown5: |
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| TGRDollars1: |
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| ACDBEjvPercent1: |
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| ACDBEjvPercent2: |
| 0: |
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| ACDBEjvPercent3: |
| 0: |
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| Solicitation Type: [REQUEST FOR PROPOSAL] |
| Attachment: [--] |
| Text4: 240757 |
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