DMI-30-Form-Payment-Package-or-Final-with_Invoices_SLBE_ADAv3.pdf
PDF 197 KB Posted
- Attached to
- Repairs for Diesel Engine Vehicles & Equipment
- Solicitation number
- 26-P-00237
- Issued by
- Hillsborough County, Florida
About this file
This is a payment form document (DMI-30 Form) issued by the City of Tampa for processing payments to subcontractors, consultants, and suppliers on municipal contracts. The form is used to document and track subcontractor payments during contract performance periods and must be submitted with all invoicing or payment requests when subcontracting has occurred. The form requires contractors to provide contract identification information, pay period dates, payment request sequence numbers, total amounts requested, and comprehensive subcontractor details including company information, federal identification numbers, and payment amounts. Contractors must certify the accuracy of all information provided and submit the completed form with supporting documentation such as waiver and release of lien forms or affidavits of payment. The City of Tampa's Office of Equal Business Opportunity enforces compliance with Ordinance 2008-89, and incomplete or unsigned forms may result in non-compliance determinations.
The DMI-30 Form tracks payment data for both partial and final payments and requires documentation of amounts paid to date, amounts pending from previously reported periods, and amounts to be paid for the current period. The form includes designation of subcontractor ownership type, distinguishing between Small Local Business Enterprises (SLBE) designated as "S" and other business types designated as "O." Failure to complete the form accurately, sign and date the document, or provide required supporting documentation can result in a company being determined non-compliant with City ordinance. The form accommodates up to six subcontractors per payment period and requires contractors to provide the sub pay period ending date for each subcontractor's invoiced work, with inquiries directed to the Office of Equal Business Opportunity at (813) 274-5522.
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Text version
Page 1 of 2 –DMI Payment City of Tampa – DMI Sub-(Contractors/Consultants/Suppliers) Payments
(DMI 30 FORM)
[] Partial [] Final
Contract No.: WO (if any): Contract Name: ____________________ Contractor Name: Address: ________________________________
Federal ID: Phone: Fax: Email: _________________ GC Pay Period: Payment Request/Invoice Number: City Department: ______________
Total Amount Requested for pay period: $____________ Total Contract Amount (including change orders): $___________ -Type of Ownership - S = SLBE, O = Other
Type, Federal ID
Company Name Address
Phone & Fax
Total Subcontract
Or PO Amount
Amount Paid To Date
Amount To Be Paid
For This Period
Amount Pending Previously Reported
Sub Pay Period Ending Date
(Modifying This Form or Failure to Complete and Sign May Result in Non-Compliance) Certification: I hereby certify that the above information is a true and accurate account of payments to subcontractors/consultants on this contract.
Signed: Name/Title: Date:
DMI 30 form (rev. 01/2026) Note: Detailed Instructions for completing this form are on the next page Forms must be signed and dated, or they will be considered incomplete. Failure to sign this document or return it unsigned can be cause for determining that a company is in non-compliance with Ordinance 2008-89.
Page 2 of 2 – DMI Payment Instructions for completing DMI Sub-(Contractor’s/Consultants/ Suppliers)Payment Form(DMI 30)
This form must be submitted with all invoicing or payment requests where there has been subcontracting rendered for the pay period. If applicable, after payment has been made to the subcontractor, “Waiver and Release of Lien upon Progress Payment”, “Affidavit of Contractor in Connection with Final Payment”, or an affidavit of payment must be submitted with the amount paid for the pay period.
(Modifying or omitting information from this form may result in non-compliance.)
• Contract No. This is the number assigned by the City of Tampa for the proposal.
• W.O. If the report covers a work order number (W.O. for the contract, please indicate it in that space.
• Contract Name. This is the name of the contract assigned by the City of Tampa for the bid or proposal.
• Contractor Name. The name of your business.
• Address. The physical address of your business.
• Federal ID. A number assigned to a business for tax reporting purposes.
• Phone. Telephone number to contact the business.
• Fax. Fax number for business.
• Email. Provide email address for electronic correspondence.
• Pay Period. Provide start and finish dates for the pay period. (e.g. 05/01/13 – 05/31/13)
• Payment Request/Invoice Number. Provide a sequence number for payment requests. (ex. Payment one, write 1 in the space, payment three, write 3 in the space provided.)
• City Department. The City of Tampa department to which the contract pertains.
• Total Amount Requested for the pay period. Provide all the dollars you are expecting to receive for the pay period.
• Total Contract Amount (including change orders). Provide the expected total contract amount.
• Signed/Name/Title/Date. This is your certification that the information provided on the form is accurate.
• See attached documents. Check if you have provided any additional documentation relating to the payment data. Located at the bottom middle of the form.
• Partial Payment. Check if the payment period is a partial payment, not a final payment.
• Final Payment. The check for this period is the final payment period.
The following instructions are for the information of all subcontractors used for the pay period.
• (Type) of Ownership. Indicate SLBE or Other.
• Federal ID. A number assigned to a business for tax reporting purposes.
• Company Name, Address, Phone & Fax. Provide company information for payment verification.
• Total Subcontract Amount. Provide the total amount of subcontract for the subcontractor, including change orders.
• Amount Paid to Date. Indicate all dollars paid to date for the subcontractor.
• Amount Pending, Previously Reported. Indicate any amount previously reported for which payments are pending.
• Amount To Be Paid for this Period. Provide the dollar amount requested for the pay period.
• Sub Pay Period Ending Date. Provide the date for which the subcontractor invoiced for the work performed.
If any additional information is required or you have any questions, you may call the Office of Equal Business Opportunity at (813) 274-5522.
| Contract No: |
| WO if any: |
| Contract Name: |
| Contractor Name: |
| Address: |
| Federal ID: |
| Phone: |
| Fax: |
| Email: |
| GC Pay Period: |
| Payment RequestInvoice Number: |
| City Department: |
| Total Contract Amount including change orders: |
| Type Federal IDRow1: |
| Company Name Address Phone FaxRow1: |
| Total Subcontract Or PO AmountRow1: |
| Amount Paid To DateRow1: |
| Amount To Be Paid For This PeriodRow1: |
| Amount Pending Previously ReportedRow1: |
| Sub Pay Period Ending DateRow1: |
| Type Federal IDRow2: |
| Company Name Address Phone FaxRow2: |
| Total Subcontract Or PO AmountRow2: |
| Amount Paid To DateRow2: |
| Amount To Be Paid For This PeriodRow2: |
| Amount Pending Previously ReportedRow2: |
| Sub Pay Period Ending DateRow2: |
| Type Federal IDRow3: |
| Company Name Address Phone FaxRow3: |
| Total Subcontract Or PO AmountRow3: |
| Amount Paid To DateRow3: |
| Amount To Be Paid For This PeriodRow3: |
| Amount Pending Previously ReportedRow3: |
| Sub Pay Period Ending DateRow3: |
| Type Federal IDRow4: |
| Company Name Address Phone FaxRow4: |
| Total Subcontract Or PO AmountRow4: |
| Amount Paid To DateRow4: |
| Amount To Be Paid For This PeriodRow4: |
| Amount Pending Previously ReportedRow4: |
| Sub Pay Period Ending DateRow4: |
| Type Federal IDRow5: |
| Company Name Address Phone FaxRow5: |
| Total Subcontract Or PO AmountRow5: |
| Amount Paid To DateRow5: |
| Amount To Be Paid For This PeriodRow5: |
| Amount Pending Previously ReportedRow5: |
| Sub Pay Period Ending DateRow5: |
| Type Federal IDRow6: |
| Company Name Address Phone FaxRow6: |
| Total Subcontract Or PO AmountRow6: |
| Amount Paid To DateRow6: |
| Amount To Be Paid For This PeriodRow6: |
| Amount Pending Previously ReportedRow6: |
| Sub Pay Period Ending DateRow6: |
| NameTitle: |
| Date: |
| Total Amount Requested for Pay Period: |
| Partial: Off |
| Final: Off |
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