Form C-63 - Activity Report - Virginia Department Of Transportation (Page 2 of 2) in pdf

Form C-63 - Activity Report - Virginia Department Of Transportation Page 2

Form C-63

Rev.. 4-19-99

INSTRUCTIONS

All "amounts paid" to certified D/MBEs, which are to be claimed as participation credit, are to be

reported. "Amount paid" includes, but is not necessarily limited to, payment for subcontracting,

furnishing materials, supplies, or services; and equipment leasing. The Prime Contractor's

Form C-63 should show "Page 1 of " with all attachments numbered sequentially and

submitted as a single package. All forms C-63 and C-63A for a particular reporting period and

project shall be transmitted together and submitted by the Contractor's estimate date.

Data should be reported as follows:

Date of Execution: Date of execution of the contract by VDOT

Allowable Credit of Contract or Agreement: Dollar value of contract or agreement or, if

open contract or agreement, show estimated dollar value of work to be performed by the

D/MBE during the contract or agreement which is allowable for participation credit.

Allowable Credit This Month: Portion of the dollar amount that can be credited to D/MBE

participation this month.

Total Cost To Date: Total dollar amount of payments made to D/MBE for work performed

since work commenced.

Disallowed Credit This Month: Portion of the dollar amount that can NOT be credited to

DBE/WBE participation this month.

Disallowed Credit To Date: Portion of the dollar amount paid to D/MBE that is NOT

allowable for participation credit.

Type of Work: Subcontractor, Materials Supplier, Services (such as hauling, equipment

leasing, consultant), and Other (specify).

A brief description should be included

(example: subcontractor misc. concrete, landscaping)

Minority-owned Firms: All minority –owned firms, whether DBE or MBE.

Female-owned Firms: All female-owned firms whether DBE or MBE, except for minority

female-owned firms where credit is being claimed under the minority owned designation.

Form C-63 - Activity Report - Virginia Department Of Transportation Page 2