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DBE Award Information for Contractors and Consultants on Locally Let Federal Aid ContractsCounty: FORMTEXT ?????PIN: FORMTEXT ?????Contract Award Amount: FORMTEXT ?????Federal Project Number: FORMTEXT ?????Federal Dollars in Contract: FORMTEXT ?????State Project Number: FORMTEXT ?????Contract Award Date: FORMTEXT ?????Name of Prime Contractor: FORMTEXT ?????Proposed DBE Goal or None: FORMTEXT ?????% or FORMCHECKBOX None*This form must be resubmitted to Local.Programs@ if the DBEs change on the project. NAMES OF SUBCONTRACTORSETHNICITY**GENDERSUBCONTRACT AMOUNT FORMTEXT ?????DBE Certified Work Type to be performed: FORMTEXT ????? FORMCHECKBOX 2nd Tier FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ?????DBE Certified Work Type to be performed: FORMTEXT ????? FORMCHECKBOX 2nd Tier FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ?????DBE Certified Work Type to be performed: FORMTEXT ????? FORMCHECKBOX 2nd Tier FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ?????DBE Certified Work Type to be performed: FORMTEXT ????? FORMCHECKBOX 2nd Tier FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ?????DBE Certified Work Type to be performed: FORMTEXT ????? FORMCHECKBOX 2nd Tier FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????TOTAL DBE COMMITMENT:$ FORMTEXT ?????SUBMITTED BY: FORMTEXT ?????DATE: FORMTEXT ?????**Ethnicity= Black American (BA), Hispanic American (HA), Native American (NA), Asian Indian American (AIA), Asian-Pacific American (APA), Non-Minority Women (FBE), Other (OT) ................
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