Sheet 1: Prime Qtrly Compl Rep

	
	
	
	
	
	
	
	

		

 
		
		
USF TAMPA CERTIFIED/NON-CERTIFIED (CMBE/NON-CMBE)
		


		
CURRENT DATE:
		
8/8/2022
		


	
	

		
MINORITY BUSINESS ENTERPRISE
		


		


		


		


	
	

		
PARTICIPATION COMPLIANCE REPORT FORM - CONSTRUCTION/ A&E PROJECTS
		
*REPLY "NO DATA TO REPORT" BY EMAIL, IF THERE IS NO SPEND TO REPORT*ALL AREAS IN GRAY SHOULD BE COMPLETED IF APPLICABLE
		


	
	

		
Reporting Period Quarter:
		


		


		


	
	

		
Fiscal Year:
		


		


		


	
	

		
Prime Contractor (Business Name)/Construction Manager:
		


		
Prime Contractor                    Business Classification
		
CORPORATION
		


	
	

		
OTHER: Prime Contractor (Business Name)/Construction Manager (Type Name in space if not in drop down):
		


		


	
	

		
USF Project Title (Type Project in space if not in drop down):
		


		


	
	

		


		
USF Project No./Bid No.(Type Project or Bid No. in space if not in drop down):
		


		


	
	

		
THIS FORM IS TO BE COMPLETED BY                            PRIME CONTRACTORS ONLY
		
Project Manager (Type Name in space if not in drop down):
		
Tim Franke
		


	
	

		
Subcontractor Business Name
		
   CMBE CODE                   
		
    Dollar Amount Paid
		
SUB/FEID#
		
CATEGORY
		
Date Paid
		
Subcontractor Contact Information (enter: email address or telephone number)
	
	

		
SELECT ONE
		


		


		
75-3168648
		


		


		


	
	

		
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SUBTOTAL
		


		


		


		


		


	
	

		
Subcontractor Business Name
		
NON CMBE CODE
		
    Dollar Amount Paid
		
SUB/FEID#
		
CATEGORY
		
Date Paid
		
Subcontractor Contact Information (enter: email address or telephone number)
	
	

		
SELECT ONE
		
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SUBTOTAL
		
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GRAND TOTAL
		


		


		


		


		


	
	

		

I CERTIFY THAT THE INFORMATION SUPPLIED HEREIN, INCLUDING ALL ATTACHMENTS, IS CORRECT TO THE BEST OF MY KNOWLEDGE.  I FURTHER CERTIFY THAT IN FLORIDA MY FIRM IS IN COMPLIANCE WITH CHAPTER 112, FLORIDA STATUTES RELATING TO CONFLICT OF INTEREST (TO REVIEW THE STATUTE IN FULL, VISIT HTTP://WWW.FLSENATE.GOV/STATUTES). BY TYPING YOUR SIGNATURE BELOW YOU ACKNOWLEDGES THAT YOU HAVE VERIFIED THE SUBCONTRACTOR’S CERTIFICATION STATUS AND ALL PAYMENTS ARE RECORDED ON THIS FORM FOR THE QUARTER. 

		


	
	

		
Prepared By
		


		
Email
		


		


	
	

		
Title
		


		
Telephone
		


		


	
	

		
Date
		


		
Fax
		


		


	
	

		
Signature
		


		
PLEASE EMAIL THIS FORM IN EXCEL FORMAT ONLY. PLEASE DO NOT FAX OR MAIL THIS FORM.
		


	
	

		
*This form should be submitted by email only* (Please TYPE your name in the text box above) Revised 12112012
		
Retun Form to mahernandez@usf.edu
		


	
	

		


		


		


		


		


		


		


	
	

		
Quarterly Reporting Requirements for Prime Contractors (Form) Due  Quarterly by: January 14/April 14/July 14/October 16
		


		


	
	

		
WEBPAGE WHERE FORM IS LOCATED: http://usfweb2.usf.edu/purchasing/forms.html