Form C-63 - Activity Report - Virginia Department Of Transportation
ADVERTISEMENT
1
2Form C-63
Rev.. 4-19-99
COMMONWEALTH OF VIRGINIA
Page
Of
DEPARTMENT OF TRANSPORTATION
Report No.
D/MBE
Month Ending
ACTIVITY REPORT
Semi-Final
Final
Order No.
Date of Execution
Contractor/Subcontractor
Route No.
Project No.
Contract Id. No.
FHWA No
District
Allowable
Disallowed
Allowable
(Indicate Item
Total
D/MBE Firm Name,
Credit of
Credit
Credit
Nos. Involved)
Cost To
Certification No.
Contract or
Type of
This
To
This
To
Date
Agreement
Work
Month
Date
Month
Date
Minority-Owned
Grand Total or
Total This Page
Female-Owned
All "amounts paid" to certified D/MBEs, which are to be claimed As
I/WE certify that the information shown is accurate and complete to the best of
participation credit, are to be reported. One copy of this report is to be
my/our Knowledge.
Signed
Date
submitted by the Contractor's estimate date. See Reverse Side for
Instructions
Title
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal