DMI-30-Form-Payment-Package-or-Final-with_Invoices_SLBE.pdf
PDF 257 KB Posted
- Attached to
- Lease of Property Located at 2806 N. 15th Street
- Solicitation number
- 26-P-00147
- Issued by
- Hillsborough County, Florida
About this file
This is a DMI 30 Form payment documentation file for the City of Tampa used to report payments made to subcontractors, consultants, and suppliers on municipal contracts. The form serves as a compliance requirement under City of Tampa Ordinance 2008-89 and must be submitted with all invoicing or payment requests when subcontracting work has been performed during a pay period. The form requires contractors to provide comprehensive information including contract number, contractor identification, pay period dates, total amount requested for the period, total contract amount including change orders, and detailed information for each subcontractor or supplier utilized. Supporting documentation such as waivers and releases of lien or affidavits of payment must be submitted with the form following payment to subcontractors. The form includes designation fields for ownership type (SLBE or Other) and requires certification by an authorized representative with signature and date.
The DMI 30 Form functions as a tracking and verification mechanism for subcontractor payments and serves to ensure compliance with small local business enterprise (SLBE) utilization requirements. Contractors must identify the trade or work activity provided by each subcontractor, the total subcontract amount including change orders, amounts previously paid to date, amounts pending from prior reporting periods, and the specific amount to be paid in the current period. Failure to complete the form accurately, modify the form, or return it unsigned can result in a determination of non-compliance with City ordinances. The form accommodates up to six subcontractors or suppliers per submission and includes checkboxes to indicate whether the payment represents a partial or final payment for the contract term. Contractors requiring additional assistance with form completion may contact the City of Tampa 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
Company Name Address
Phone & Fax
Total Subcontract
Or PO Amount
Amount Paid To Date
Amount To Be Paid
For This Period Trade/Work
Activity [] Sub [] Supplier
Amount Pending Previously Reported
Sub Pay Period Ending Date Federal ID
(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. 08/2025)
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 The 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.OO. 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.
• Trade/Work Activity. Indicate the trade, service, or material provided by the subcontractor.
• Subcontractor/Subconsultant/Supplier. Please indicate the status of the firm on this contract.
• Federal ID. A number assigned to a business for tax reporting purposes.
• Company Name, Address, Phone & Fax. Provide company information for verification of payments.
• 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 Amount Requested for pay period: |
| Total Contract Amount including change orders: |
| Type of Ownership S SLBE O Other: |
| Federal IDRow4: |
| Company Name Address Phone FaxRow1: |
| Total Subcontract Or PO AmountRow1: |
| Row1: |
| Row1_2: |
| Federal IDRow8: |
| Company Name Address Phone FaxRow2: |
| Total Subcontract Or PO AmountRow2: |
| Row1_3: |
| Row1_4: |
| Federal IDRow12: |
| Company Name Address Phone FaxRow3: |
| Total Subcontract Or PO AmountRow3: |
| Row1_5: |
| Row1_6: |
| Federal IDRow16: |
| Company Name Address Phone FaxRow4: |
| Total Subcontract Or PO AmountRow4: |
| Row1_7: |
| Row1_8: |
| Federal IDRow20: |
| Company Name Address Phone FaxRow5: |
| Total Subcontract Or PO AmountRow5: |
| Row1_9: |
| Row1_10: |
| Federal IDRow24: |
| Company Name Address Phone FaxRow6: |
| Total Subcontract Or PO AmountRow6: |
| Row1_11: |
| Row1_12: |
| NameTitle: |
| Date: |
| Check Box12: Off |
| Check Box13: Off |
| Text16: |
| 0: |
| 1: |
| Text17: |
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| Text18: |
| 0: |
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| Text19: |
| 0: |
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| Text15: |
| 0: |
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| Text14: |
| 0: |
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| Type: |
| 0: |
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| Trade: |
| 0: |
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| Sub or Supplier: |
| 0: |
| 1: |
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