Exhibit_4_-_Monthly_Compliance_Status_Report.pdf

EXHIBIT 4

MONTHLY

COMPLIANCE STATUS

REPORT

Small and Minority Business Participation

Completed reports must be submitted as follows:

Beaufort County Compliance Office P.O. Drawer 1228 • Beaufort, SC 29901-1228 E-Mail: dthomas@bcgov.net • FAX 843.255.9437

Prime Contractor Name:

Project Name:

Type of Report:

Report Number:

For the Period Of:

Monthly Final

Until the project ends, the Prime Contractor shall submit monthly reports to the Compliance Office by the 5th day, reflecting activity of the previous month.

Original Prime Contract Amount:

Change Orders to Date:

Current Prime Contract Amount:

Name of

S/MBE

Firm Type

Quote Amount

Date of Contract/PO

Dollar Amount of Actual

Contract/PO

Dollar Amount

Paid This Month

Check Number

Dollar Amount Paid to

Date

SBE Expenditure to Date:

MBE Expenditure to Date:

S/MBE Total Expenditure to Date:

I certify that contracts/purchase orders have been executed with the above firms, amounts listed are accurate, and payments were made in accordance with contractual obligations. Cancelled checks to S/MBEs working on this project and/or supporting documentation for the information presented in this report will be made available to Beaufort County officials upon written request.

Name: Title:

Signature: Date:

Small and Minority Business Participation Program Documents – Beaufort County, South Carolina Revised 2 February 2022