Form S3c - Section 3 Project Summary Page 2
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4S3-C Rev 1/2014
SECTION 3 PROJECT SUMMARY
Sponsor/Contractor Name:
HPD Program:
HPD Contact Person:
Address:
Contract Description:
City/Zip:
Contract Amount:
Project:
Person Completing This Form:
Email Address:
Date:
Report Period and Year:
CHECK
Type of Contract
NAME OF
TOTAL
If Sec. 3
NAME & ADDRESS OF ALL
(Specify trade,
PRIME
CONTRACT
Certified
BUSINESSES ON-SITE
professional
CONTRACTOR
AWARD
Business*
(A)
service, etc.)
(D)
(E)
(B)
(C)
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Name:
Address:
$
City/Zip:
Section 3 Business Concerns must have a Section 3 Business Certification form on file with agency.
COPY THIS FORM AS NEEDED
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Parent category: Legal