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Diversity & Inclusion Department

EO Vendor Payment Report Form

View the Vendor Payment Report form (PDF file)
View the Vendor Payment Report Commodities form (PDF file)

To print the form: Click on the link above, set your printer orientation to landscape and select "Fit to page" or "Shrink oversized pages to paper size."

Instructions for Contractors "How To Fill Out Vendor Payment Report"

The Vendor Payment Report is to be filled out by the Contractor and submitted with each invoice. The instructions below correspond to each item on the report. Please follow the instructions.

1. Invoice No.
Fill in the invoice number accompanying this report.

2. Report No.
Fill in the number of the report you are sending in sequence.
For example: If this is the second invoice you are submitting, you are sending in Report No. 2.

3. Reporting period
This is to be filled in to state the period of time you are reporting.
Example: From: April 1, 1991 To: April 30, 1991

4. DART Contract Number
Fill in the contract number assigned to your project by DART.

5. Type of Contract
Designate the type of contract that has been awarded your company by DART.

6. Contractor's Business Name, Address and Telephone Number
Fill in your company's name, address and telephone number.

7. Date of Contract Award
Fill in the date contract was executed by both you and DART.

8. Scheduled Date of Completion
Fill in completion date of contract as written in contract.

9. Original Contract Amount
Fill in dollar amount of original contract agreed upon by you and DART.

10. Current Contract Amount (including modifications)
Fill in dollar amount of contract including all modifications.

11. Total Amount Received to Date
Fill in dollar amount you have received from DART to-date.

12. Total Amount Owed
Fill in the dollar amount of the contract minus amount paid to you by DART minus current invoice.

13. Committed Disadvantaged/Minority/Woman-Owned Participation
Fill in the percentage of D/M/WBE participation you committed to obtain on the contract.

14. Instructions for Calculation of Disadvantaged/Minority/Woman-Owned Business Enterprise Percentage.
Dollar amount paid to D/M/WBE divided by dollars received by Contractor from DART.

15. Actual Disadvantaged/Minority/Woman-Owned Business Enterprise Percent Paid-to-Date
Fill in the calculated dollar amount paid to the D/M/WBE divided by the dollar amount you received from DART.

16. Name of Subcontractors
Name all D/M/WBE subcontractors (Use additional sheets as necessary.)

17. Disadvantaged/Minority/Woman-Owned Business Enterprise
State whether the subcontractor is a DBE/MBE/WBE.

18. Description of Work
State the work performed by the D/M/WBE subcontractor.

19. Amount and Date of Payment(s) Made During Current Invoice Period
State the amount and date of payment(s) made to each D/M/WBE subcontractor during current invoice period. Submit evidence of payment, i.e. cancelled check, check register, etc.

20. Subcontract Value (Dollars)
State the committed dollar value to the D/M/WBE subcontractor for the duration of the contract.

21. Total Amount Paid-To-Date (Dollars)
Add all amounts paid to each D/M/WBE subcontractor to-date.

22. Percent of Earned Progress to Date
State dollar amount paid to the D/M/WBE subcontractor divided by the amount committed to them.

23. Amount of This Invoice Allocated to the Subcontractor
Fill in how much of this invoice will be paid to each D/M/WBE subcontractor.

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