Contractors Report of DBE Participation Instructions for Completing Report

New Orleans Aviation Board

New Orleans International Airport

Contractor Report of DBE Participation

Instructions for Completing Report

As per your agreement with the New Orleans Aviation Board, your firm is required to complete a report of Disadvantaged Business Enterprise (DBE) participation. This report should consist of firms whereby purchases of goods and/or services have been purchased during the reporting period.

DBE-certified means federally certified by a member of the Louisiana Unified Certification Program (www.LAUCP.org). SLDBE-certified means locally certified with the State & Local Disadvantaged Enterprise Program through the New Orleans Aviation Board, City of New Orleans, Sewerage & Water Board, or Jazz Casino Company, LLC d/b/a Harrah’s New Orleans Jazz Casino.

The following are definitions of each of the reporting category:

1. Amount Paid to Prime This Month – Monies received on contract this Month

2. Amount Paid to Prime To Date – Monies received on contract during the life of the contract

3. DBE/SL Original Contract Amount – If any DBE/SL firms are under contract with your company, indicate the total original amount of the agreements. If any DBE/SL firms have purchase orders to provide services/items, indicate the total original purchase order amounts.

4. DBE/SL Current Contract Amount – If any DBE/SL firms are under contract with your company, indicate the total current amount of the agreements. If any DBE/SL firms have a purchase orders to provide services/items, indicate the total current purchase order amounts.

5. Amount Paid to DBE/SL This Month – Indicate only the total amount actually paid to any DBE/SLs during the period. As part of the NOAB’s DBE/SL verification process, we are requesting that your firm submit verification of payments made to any DBE/SLs on the expenditures reported. This can be achieved by providing copies of accounts payables ledgers or copies of canceled checks.

6. Amount Paid to DBE/SL To-Date – Indicate only the total amount actually paid to any DBE/SLs during the life of the contract

7. Subcontractor/Vendor Name – Provide name of subcontractor/vendor

8. DBE/SL Certification Percentage at Contract Inception – Indicate DBE/SL certification percent of subcontractor’s firm when subcontract signed. If company was 100% DBE-certified, enter 100. If company is a joint venture with a non-DBE firm, enter DBE JV percentage. If regular dealer or supplier, only 60% of DBE/SL certification percentage may be counted.

9. Description of Service – Describe type of service subcontractor is contracted to perform

10. Original Contract Amount – If subcontractor is under contract with your company, indicate the original amount of the agreement. If subcontractor has a purchase order to provide services/items, indicate the original purchase order amount.

11. Current Contract Amount – If subcontractor is under contract with your company, indicate the current amount of the agreement. If subcontractor has a purchase order to provide services/items, indicate the current purchase order amount.

12. Dollars Paid This Month – Payments made to subcontractor this Month

13. Dollars Paid To Date – Payments made to subcontractor during the life of the contract

ii

New Orleans International Airport
Disadvantaged Business Enterprise (DBE) / State & Local Disadvantaged Business Enterprise (SLDBE)
Monthly Activity Report of DBE Participation

PAGE OF .

MONTH: 1ST Qtr- 2ND Qtr- 3RD Qtr- 4TH Qtr- YEAR: .
PRIME CONTRACTOR
PROJECT TITLE

Schedule J-2

New Orleans International Airport

Disadvantaged Business Enterprise (DBE) / State & Local Disadvantaged Business Enterprise (SLDBE)

Monthly Activity Report

Project Type DBE or SLDBE:
DBESLDBE / YEAR
. / First Quarter
JanuaryFebruaryMarch
(month) / Second Quarter
AprilMayJune
(month) / Third Quarter
JulyAugustSeptember
(month) / Fourth Quarter
OctoberNovemberDecember
(month)
PRIME CONTRACTOR
ADDRESS
PROJECT TITLE NOAB PROJECT NO. AMC PROJECT NO. (INTERNAL USE ONLY)
TELEPHONE NO. FAX NO. E-MAIL
Amount Paid To Prime
This Month / Amount Paid To Prime
To Date / DBE/SL Original Contract /
P.O. Amount / DBE/SL Current Contract
Amount / Amount Paid To DBE/SL
This Month / Amount Paid To DBE/SL
To Date
$ / $ / $ / $ / $ / $

List all subcontractor payments (DBE/SL and non-DBE/SL) made during this reporting period, and indicate their DBE/SL percentage at contract inception (between 0 and 100).

SUBCONTRACTOR / VENDOR NAME / DESCRIPTION OF
SERVICE / Original Contract
Amount / Current Contract
Amount / Dollars Paid This Month / Dollars Paid To Date /
DBE/SL certification percentage at contract inception à / 0-100 /
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00
$ / $ / $ / $ / 0.00 / 0.00 / 0.00 / 0.00