Exhibit_K_-_MWBE_Information_&_Form.pdf

278 KB Posted

Attached to
CDBG-DR New Smyrna Beach Corbin Park Stormwater Improvements Construction
Solicitation number
26-B-20KW
Issued by
Volusia County, Florida

About this file

Written by GovTribe AI ·

This is a Minority & Women Business Enterprise (MWBE) reporting form issued by the County of Volusia Office of Recovery and Resiliency for the CDBG-DR New Smyrna Beach Corbin Park Stormwater Improvements Construction project. The form serves as the mandatory reporting mechanism for all contractors and subcontractors executing work on this federally-funded construction project. Contractors and subcontractors must complete detailed entries documenting contract and subcontract activities, including those subcontracts valued at less than $10,000 if they represent a significant portion of total contracting activity. The project, funded through a U.S. Department of Housing and Urban Development Community Development Block Grant for Disaster Recovery (CDBG-DR), encompasses stormwater management improvements valued at approximately $8.45 million with a substantial completion period of 600 days and final completion 30 days thereafter.

The reporting form requires contractors and subcontractors to provide specific coded information across multiple fields, including contract or subcontract dollar amounts (Section 7a), type of trade classification (Section 7b), business racial/ethnic/gender codes (Section 7c), women-owned business status (Section 7d), prime contractor IRS/FEIN identification numbers (Section 7e), subcontractor IRS/FEIN identification numbers (Section 7f), and complete business name and address information (Section 7g). Trade codes differentiate between new construction, education/training, and other services including supplies and professional services. Racial/ethnic codes classify businesses as White American, Black American, Native American, Hispanic American, Asian/Pacific American, or other categories. Subcontracts must identify their associated prime contractor, and all firms receiving contract or subcontract activity must be reported only once per reporting period. The form accommodates reporting for up to eleven contracts or subcontracts and requires signatory certification with name, title, date, and signature of an authorized representative.

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County of Volusia Office of Recovery and Resiliency

1578 N. Woodland Blvd DeLand, FL 32720

Minority & Women Business Reporting Form (MWBE) Information and Instructions for Contractors & Subcontractors

Reporting

This report shall be completed by all contractors and subcontractors for reporting contract and subcontract activities for construction projects as required by the County of Volusia Office of Recovery and Resiliency. Subcontracts of less than $10,000 must be reported individually only if such contracts represent a significant portion of the total contracting activity.

• Section 7a:

Amount of Contract/Subcontract: Enter the dollar amount rounded to the nearest dollar. If subcontractor

ID number is provided in 7f, the dollar figure would be for the subcontract only and not for the prime contract.

• Section 7b:

Type of Trade: Enter the numeric code which best indicates each contractor’s/subcontractor’s service type. If subcontractor ID number is provided in 7f, the type of trade code would be for the subcontractor only and not for the prime contractor.

* The “other” category includes supply, professional services, and all other activities except construction and education/training activities

• Section 7c:

Business Racial/Ethnic/Gender Code: Enter the numeric code which best indicates the racial/ethnic/gender character of the owner(s) and controller(s) of 51% of the business. When 51% or more is not owned and controlled by any single racial/ethnic/gender category, enter the code which seems most appropriate. If the subcontractor ID number is provided, the code would apply to the subcontractor and not the prime contractor

• Section 7d:

Women Owned Business: Enter “yes” or “no” to if each listed agency is women owned

• Section 7e:

Contractor Identification Number: Enter the Employer (IRS/FEIN) Number of the Prime Contractor as the unique identifier of the prime recipient of HUD funds. Note that the Employer (IRS) Number must be provided for each contract/subcontract awarded.

• Section 7f:

Subcontractor Identification Number: Enter the Employer (IRS/FEIN) Number of the subcontractor as the unique identifier for each subcontract awarded from HUD funds. When the subcontractor ID number is provided, the respective Prime Contractor ID Number must also be provided.

• Section 7g:

Contractor/Subcontractor Business Name and Address: Enter this information for each firm receiving contract/subcontract activity only one time on each report for each firm.

Amount of Contract or

Subcontract

7a.

Type of Trade

Code

(See below)

7b.

Contractor or

Subcontractor

Business

Racial/Ethnic

(See below)

7c.

Woman Owned

Business

(Yes or No)

7d.

State Zip

1= White Amercians

2= Black Americans

3= Native Americans

4= Hispanic American

Subcontractor

Identification

Number

(IRS/FEIN)

7f.

Project Name: ____________________________________________________________________

Prime Contractor

Identification

Number

(IRS/FEIN)

7e.

Contractor/Subcontractor Business Name and Address

7g.

StreetBusiness Name

County of Volusia Office of Recovery and Resiliency - Contract and Subcontract - Minority and Women Business Reporting Form

7c: Racial/

Ethnic Codes

Name/Title: _______________________________________________ Signature: ___________________________________________ Date: _______________________

5= Asian/Pacific American

3 = Other

2 = Education/Training

7b: Type of Trade Codes:

CPD

1 = New Construction

City

Project Name:
Amount of Contract or Subcontract 7aRow2:
Type of Trade Code See below 7bRow2:
Contractor or Subcontractor Business RacialEthnic See below 7cRow2:
Woman Owned Business Yes or No 7dRow2:
Prime Contractor Identification Number IRSFEIN 7eRow2:
Subcontractor Identification Number IRSFEIN 7fRow2:
Business NameRow1:
StreetRow1:
CityRow1:
StateRow1:
ZipRow1:
Amount of Contract or Subcontract 7aRow3:
Type of Trade Code See below 7bRow3:
Contractor or Subcontractor Business RacialEthnic See below 7cRow3:
Woman Owned Business Yes or No 7dRow3:
Prime Contractor Identification Number IRSFEIN 7eRow3:
Subcontractor Identification Number IRSFEIN 7fRow3:
Business NameRow2:
StreetRow2:
CityRow2:
StateRow2:
ZipRow2:
Amount of Contract or Subcontract 7aRow4:
Type of Trade Code See below 7bRow4:
Contractor or Subcontractor Business RacialEthnic See below 7cRow4:
Woman Owned Business Yes or No 7dRow4:
Prime Contractor Identification Number IRSFEIN 7eRow4:
Subcontractor Identification Number IRSFEIN 7fRow4:
Business NameRow3:
StreetRow3:
CityRow3:
StateRow3:
ZipRow3:
Amount of Contract or Subcontract 7aRow5:
Type of Trade Code See below 7bRow5:
Contractor or Subcontractor Business RacialEthnic See below 7cRow5:
Woman Owned Business Yes or No 7dRow5:
Prime Contractor Identification Number IRSFEIN 7eRow5:
Subcontractor Identification Number IRSFEIN 7fRow5:
Business NameRow4:
StreetRow4:
CityRow4:
StateRow4:
ZipRow4:
Amount of Contract or Subcontract 7aRow6:
Type of Trade Code See below 7bRow6:
Contractor or Subcontractor Business RacialEthnic See below 7cRow6:
Woman Owned Business Yes or No 7dRow6:
Prime Contractor Identification Number IRSFEIN 7eRow6:
Subcontractor Identification Number IRSFEIN 7fRow6:
Business NameRow5:
StreetRow5:
CityRow5:
StateRow5:
ZipRow5:
Amount of Contract or Subcontract 7aRow7:
Type of Trade Code See below 7bRow7:
Contractor or Subcontractor Business RacialEthnic See below 7cRow7:
Woman Owned Business Yes or No 7dRow7:
Prime Contractor Identification Number IRSFEIN 7eRow7:
Subcontractor Identification Number IRSFEIN 7fRow7:
Business NameRow6:
StreetRow6:
CityRow6:
StateRow6:
ZipRow6:
Amount of Contract or Subcontract 7aRow8:
Type of Trade Code See below 7bRow8:
Contractor or Subcontractor Business RacialEthnic See below 7cRow8:
Woman Owned Business Yes or No 7dRow8:
Prime Contractor Identification Number IRSFEIN 7eRow8:
Subcontractor Identification Number IRSFEIN 7fRow8:
Business NameRow7:
StreetRow7:
CityRow7:
StateRow7:
ZipRow7:
Amount of Contract or Subcontract 7aRow9:
Type of Trade Code See below 7bRow9:
Contractor or Subcontractor Business RacialEthnic See below 7cRow9:
Woman Owned Business Yes or No 7dRow9:
Prime Contractor Identification Number IRSFEIN 7eRow9:
Subcontractor Identification Number IRSFEIN 7fRow9:
Business NameRow8:
StreetRow8:
CityRow8:
StateRow8:
ZipRow8:
Amount of Contract or Subcontract 7aRow10:
Type of Trade Code See below 7bRow10:
Contractor or Subcontractor Business RacialEthnic See below 7cRow10:
Woman Owned Business Yes or No 7dRow10:
Prime Contractor Identification Number IRSFEIN 7eRow10:
Subcontractor Identification Number IRSFEIN 7fRow10:
Business NameRow9:
StreetRow9:
CityRow9:
StateRow9:
ZipRow9:
Amount of Contract or Subcontract 7aRow11:
Type of Trade Code See below 7bRow11:
Contractor or Subcontractor Business RacialEthnic See below 7cRow11:
Woman Owned Business Yes or No 7dRow11:
Prime Contractor Identification Number IRSFEIN 7eRow11:
Subcontractor Identification Number IRSFEIN 7fRow11:
Business NameRow10:
StreetRow10:
CityRow10:
StateRow10:
ZipRow10:
Amount of Contract or Subcontract 7aRow12:
Type of Trade Code See below 7bRow12:
Contractor or Subcontractor Business RacialEthnic See below 7cRow12:
Woman Owned Business Yes or No 7dRow12:
Prime Contractor Identification Number IRSFEIN 7eRow12:
Subcontractor Identification Number IRSFEIN 7fRow12:
Business NameRow11:
StreetRow11:
CityRow11:
StateRow11:
ZipRow11:
NameTitle:
Date:

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