[Insert Housing Authority Logo]
Section 3 Monthly Activity Report
Contract Name/Number: / Project:
Contractor/Subcontractor:
DUNS # (If Stimulus Project) / Company ID Number:
Contractor/Subcontractor Address City, State, Zip Phone
Section 3 Business: r / M/WBE Status: Minority Business Enterprise * r Woman Business Enterprise r
*Ethnic/Racial Code: 1. African/American; 2. Native American; 3. Latino/Hispanic; 4. Asian/Pacific Islander; 5. Other - Explain
Person Submitting Report:
Email: / Phone:
Reporting period from: / to: / Number of New Hires during reporting period:
Name / Address / Dates & types of work hired to perform / Section 3 Resident? / PH/HCV
(Indicate Which) / Other Community Resident
Use additional sheets if needed.
Comments: Explanation of efforts made to hire Section 3 Residents (i.e., persons contacted, notices posted, etc.) Attach additional sheets if necessary.
Signature: / Date:
For PHA use only:
CHA Project Manager:
HUD Contract Number: / Construction Amount:
Non-Construction Amt: / Amt. Paid to this Reporting Period:
Program Code: Mod. Dev. CFP Op. HOPE VI New Construction Other: