Form CEM-2406 "Monthly Disadvantaged Business Enterprises (Dbe) Payment" - California

What Is Form CEM-2406?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-2406 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-2406 "Monthly Disadvantaged Business Enterprises (Dbe) Payment" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
MONTHLY DISADVANTAGED BUSINESS ENTERPRISES (DBE) PAYMENT
CEM-2406 (REV 05/2019)
PRIME CONTRACTOR
CONTRACT NO.
MONTH
YEAR
FEDERAL-AID NO.
BUSINESS ADDRESS
DEPARTMENT OF INDUSTRIAL RELATIONS NO.
CONTRACTORS STATE LICENSE BOARD NO. TASK ORDER NO.
FINAL
ITEM NUMBER(S)
DBE
DBE
NON-DBE
TOTAL
DBE/NON-DBE FIRM NAME
DATE OF
PAYMENT
COMMENTS
OF WORK
CERTIFICATION
AMOUNT
AMOUNT
AMOUNT
AND BUSINESS ADDRESS
PAYMENT
PERFORMED
NUMBER
PAID
PAID
PAID
Y/N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
List all Disadvantaged Business Enterprises (DBEs) regardless of tier, whether or not the firms were originally listed for goal credit. If actual DBE utilization (or item of work) was different
than that approved at the time of award, provide comments. List actual amount paid to each entity.
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT
CONTRACTOR REPRESENTATIVE SIGNATURE
BUSINESS PHONE NUMBER
DATE
TO THE BEST OF MY INFORMATION AND BELIEF, THE ABOVE INFORMATION IS COMPLETE AND CORRECT
RESIDENT ENGINEER'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
COPY DISTRIBUTION -
Original - Resident Engineer
Copy - District Construction
Copy - OBEO - email
business.support.unit@dot.ca.gov
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
MONTHLY DISADVANTAGED BUSINESS ENTERPRISES (DBE) PAYMENT
CEM-2406 (REV 05/2019)
PRIME CONTRACTOR
CONTRACT NO.
MONTH
YEAR
FEDERAL-AID NO.
BUSINESS ADDRESS
DEPARTMENT OF INDUSTRIAL RELATIONS NO.
CONTRACTORS STATE LICENSE BOARD NO. TASK ORDER NO.
FINAL
ITEM NUMBER(S)
DBE
DBE
NON-DBE
TOTAL
DBE/NON-DBE FIRM NAME
DATE OF
PAYMENT
COMMENTS
OF WORK
CERTIFICATION
AMOUNT
AMOUNT
AMOUNT
AND BUSINESS ADDRESS
PAYMENT
PERFORMED
NUMBER
PAID
PAID
PAID
Y/N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
List all Disadvantaged Business Enterprises (DBEs) regardless of tier, whether or not the firms were originally listed for goal credit. If actual DBE utilization (or item of work) was different
than that approved at the time of award, provide comments. List actual amount paid to each entity.
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT
CONTRACTOR REPRESENTATIVE SIGNATURE
BUSINESS PHONE NUMBER
DATE
TO THE BEST OF MY INFORMATION AND BELIEF, THE ABOVE INFORMATION IS COMPLETE AND CORRECT
RESIDENT ENGINEER'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
COPY DISTRIBUTION -
Original - Resident Engineer
Copy - District Construction
Copy - OBEO - email
business.support.unit@dot.ca.gov
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
MONTHLY DISADVANTAGED BUSINESS ENTERPRISES (DBE) PAYMENT
CEM-2406 (REV 05/2019)
Instructions
The prime contractor enters the contract number, reporting month and year, federal aid number, prime contractor name and address. For each
DBE, identify the item(s) of work performed, the DBE firm name, address, certification number, amount paid, payment date, percent of
participation credited towards contract commitment (as detailed in section 2-112B of the Standard Specifications), and total percent of work
completed to date. Use the comments section to explain any differences in the original commitment and the payments to the DBE firms.
If a firm performing work as a DBE becomes decertified during the project, enter payment information for the work performed while certified as a
DBE. If a subcontractor performing work as a non-DBE on the project becomes certified as a DBE, enter the amount paid for work performed
after certification as a DBE. Any changes to DBE certification must also be submitted on form CEM-2403F, "Disadvantaged Business
Enterprise (DBE) certification status change."
The contractor will sign, print name, and date the form indicating that the information provided is completed and correct.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
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