G Form, 2015, Monthly Report County Of Onondaga
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1ATTACHMENT G
County FAMIS Project # ____________
(G FORM)
SRF Project #
____________
Bond Act Contract #
____________
EPA Grant #
____________
Project Name:
MONTHLY REPORT
Bid Number:
County of Onondaga
Month of
Year
ENGINEER/CONTRACTOR'S MINORITY- AND WOMEN-OWNED BUSINESS ENTERPRISE (M/WBE) MONTHLY REPORT
The following information indicates the payment amounts made to the contractor by the County of Onondaga and payments made to NYS certified M/WBEs from the contractor on this
project. The payments as shown made to them are in compliance with contract documents for the above referenced project:
ENGINEER/CONTRACTOR:
CONTRACT NUMBER:
ORIGINAL CONTRACT AMOUNT:
AMOUNT PAID TO ENGINEER/CONTRACTOR THIS MONTH:
MBE Goal/Amount:
% =
WBE Goal/Amount:
% =
Work Status
Total Subcontractor
Total Payments
Subcontractor/Description of Services
Payments This Month
Previous Payments
This Report
Contract Amount
Made to Date
MBE
WBE
MBE
WBE
MBE
WBE
MBE
WBE
Active
Inactive
Complete
Active
Inactive
Complete
Active
Inactive
Complete
Active
Inactive
Complete
Active
Inactive
Complete
TOTAL
% of TOTAL CONTRACT
Date:
Signature:
Print Name:
Attachment G
Version Date: 9/2015
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