Form CEM-2402S "Final Report - Utilization of Disabled Veteran Business Enterprises (Dvbe) - State Funded Projects Only" - California

This version of the form is not currently in use and is provided for reference only.
Download this version of Form CEM-2402S for the current year.

What Is Form CEM-2402S?

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 September 1, 2014;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-2402S 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-2402S "Final Report - Utilization of Disabled Veteran Business Enterprises (Dvbe) - State Funded Projects Only" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
FINAL REPORT - UTILIZATION OF DISABLED VETERAN BUSINESS ENTERPRISES (DVBE)
For individuals with sensory disabilities, this document is available in alternate
formats. For information, call (916) 445-1233, TTY 711, or write to Records
STATE FUNDED PROJECTS ONLY
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CEM-2402S (REV 9/2014)
CONTRACT NUMBER
COUNTY
ROUTE
POST MILES
CONTRACT COMPLETION DATE
ESTIMATED CONTRACT AMOUNT
PRIME CONTRACTOR
BUSINESS ADDRESS
DESCRIPTION OF WORK
DVBE CERT NO. OR
CONTRACT PAYMENTS
CONTRACT
PERFORMED
SMALL BUSINESS
BUSINESS NAME
ITEM NO.
OR
CERT NO. FOR
PAYMENT
DATE WORK
DATE OF FINAL
AND ADDRESS
COMMENTS
MATERIALS PROVIDED
SUBSTITUTIONS
AMOUNT
COMPLETED
PAYMENT
TOTAL
ORIGINAL DVBE COMMITMENT:
List all Disabled Veterans Business Enterprises (DVBE's) regardless of tier, whether or not the firms were originally listed for contract participation. If actual DVBE utilization (or item of work) was different than that approved at
time of award, provide an explanation in the comments section. List actual amount paid to each DVBE, even if different than originally listed for contract participation. If original DVBE was substituted with another DVBE or
Small Business, provide the Department of General Services approval number and the date it was approved in the comments section.
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT
CONTRACTOR REPRESENTATIVE'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
ext.
TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS COMPLETE AND CORRECT
RESIDENT ENGINEER'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
ext.
COPY DISTRIBUTION:
Original - District Contract File
Copy - Contractor
Copy - Resident Engineer
Copy - OBEO - email
business.support.unit@dot.ca.gov
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
FINAL REPORT - UTILIZATION OF DISABLED VETERAN BUSINESS ENTERPRISES (DVBE)
For individuals with sensory disabilities, this document is available in alternate
formats. For information, call (916) 445-1233, TTY 711, or write to Records
STATE FUNDED PROJECTS ONLY
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CEM-2402S (REV 9/2014)
CONTRACT NUMBER
COUNTY
ROUTE
POST MILES
CONTRACT COMPLETION DATE
ESTIMATED CONTRACT AMOUNT
PRIME CONTRACTOR
BUSINESS ADDRESS
DESCRIPTION OF WORK
DVBE CERT NO. OR
CONTRACT PAYMENTS
CONTRACT
PERFORMED
SMALL BUSINESS
BUSINESS NAME
ITEM NO.
OR
CERT NO. FOR
PAYMENT
DATE WORK
DATE OF FINAL
AND ADDRESS
COMMENTS
MATERIALS PROVIDED
SUBSTITUTIONS
AMOUNT
COMPLETED
PAYMENT
TOTAL
ORIGINAL DVBE COMMITMENT:
List all Disabled Veterans Business Enterprises (DVBE's) regardless of tier, whether or not the firms were originally listed for contract participation. If actual DVBE utilization (or item of work) was different than that approved at
time of award, provide an explanation in the comments section. List actual amount paid to each DVBE, even if different than originally listed for contract participation. If original DVBE was substituted with another DVBE or
Small Business, provide the Department of General Services approval number and the date it was approved in the comments section.
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT
CONTRACTOR REPRESENTATIVE'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
ext.
TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS COMPLETE AND CORRECT
RESIDENT ENGINEER'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
ext.
COPY DISTRIBUTION:
Original - District Contract File
Copy - Contractor
Copy - Resident Engineer
Copy - OBEO - email
business.support.unit@dot.ca.gov
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
FINAL REPORT - UTILIZATION OF DISABLED VETERAN BUSINESS ENTERPRISES (DVBE)
STATE FUNDED PROJECTS
CEM-2402S (REV 9/2014)
The intent of this form is for the prime contractor to certify payments made to Disabled Veteran Business Enterprises (DVBE)
participating in execution of the contract. The contractor must include information on all DVBEs performing work or supplying
materials even if the DVBE firms were not listed at bid time.
The form has columns for entering specific contract items, descriptions of the services provided, the DVBE business
information and certification number, the dollar value of the work performed by the DVBE, when the work of the DVBE was
completed, the date of the final payment to the DVBE, and the original DVBE commitment amount. The comments section of the
form is for providing Caltrans with any additional information related to the DVBE payments or substitutions.
If the original listed DVBE was substituted with a Small Business Firm, include in the comments section the date of the
Department of General Services approval and the approval number.
Contractors must complete all columns for acceptance of the form. The contractor and the resident engineer sign and date the
form indicating the information provided is complete and correct.
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