Form ECY060-11 (D) "Contractor Participation Report for All Agreements" - Washington

What Is Form ECY060-11 (D)?

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

Form Details:

  • Released on July 1, 2016;
  • The latest edition provided by the Washington State Department of Ecology;
  • 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 printable version of Form ECY060-11 (D) by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY060-11 (D) "Contractor Participation Report for All Agreements" - Washington

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FORM D: CONTRACTOR PARTICIPATION REPORT
For All Agreements
Use this form:
To document voluntary and mandatory state and federal reporting requirements around Minority- and Women-Owned Business Enterprises
and Disadvantaged Business Enterprises.
When sending payment requests which include payments to any private sector contractors and subcontractors.
To track compliance with federal suspension & debarment requirements.
Indicate if no contractor expenditures to report (check box below right). (Completed Form D is required whether reporting or not.)
Agreement No:
Payment Request
Page
of
Recipient Name:
No Contractor Expenditures to Report
(Do not complete table below.)
INSTRUCTIONS: Report ALL primary contractors and sub-contractors on this form.
(1) Indicate each primary contractor and subcontractor on a separate line, listing subcontractors below the appropriate primary contractor.
(2) Identify each contractor as primary (P) or sub (S).
(3) Enter contractor address.
(4) Enter contractor phone number.
(5) Enter the contractor’s invoice amount included in the current payment request.
(6) Identify which category – Construction (C), Supplies (S), Services (SVS) or Equipment (E) – best describes the work included in this payment request.
(7) Identify type of certification – disadvantaged (DBE), minority- (MBE) or women-owned (WBE) – if applicable.
(8) Review your funding agreement to see whether this requirement applies. Federally funded agreements may require the Recipient to search the System for
Award Management (SAM) at
https://www.sam.gov/
for each of their contractors and subcontractors prior to signing contracts with them. This is to ensure the
contractors/subcontractors have not been suspended, debarred or excluded from receiving federal funds. If it applies, send the SAM search page to Ecology for
each contractor and subcontractor. If required, Ecology funding programs may withhold payment for contractor expenses if documentation is not in place.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Contractor
P=Primary
Contractor Address
Contractor
Contractor
C=Construction
Certified
SAM Search Copy
S=Sub
Phone Number
Amount
S=Supplies
DBE=Disadvantaged
Sent to Ecology?
in this Request
SVS=Services
MBE=Minority
Yes or N/A
E=Equipment
WBE=Women
FOR ECOLOGY OFFICE USE ONLY
If you need this document in a format for the visually impaired, call the Fiscal
Project #
A19 Payment Date
Fiscal Month Paid
Administrative Assistant at (360) 407-7054. Persons with hearing loss can call
711 for Washington Relay Service. Persons with a speech disability can call
877-833-6341.
ECY 060-11 Rev. 07/2016
FORM D: CONTRACTOR PARTICIPATION REPORT
For All Agreements
Use this form:
To document voluntary and mandatory state and federal reporting requirements around Minority- and Women-Owned Business Enterprises
and Disadvantaged Business Enterprises.
When sending payment requests which include payments to any private sector contractors and subcontractors.
To track compliance with federal suspension & debarment requirements.
Indicate if no contractor expenditures to report (check box below right). (Completed Form D is required whether reporting or not.)
Agreement No:
Payment Request
Page
of
Recipient Name:
No Contractor Expenditures to Report
(Do not complete table below.)
INSTRUCTIONS: Report ALL primary contractors and sub-contractors on this form.
(1) Indicate each primary contractor and subcontractor on a separate line, listing subcontractors below the appropriate primary contractor.
(2) Identify each contractor as primary (P) or sub (S).
(3) Enter contractor address.
(4) Enter contractor phone number.
(5) Enter the contractor’s invoice amount included in the current payment request.
(6) Identify which category – Construction (C), Supplies (S), Services (SVS) or Equipment (E) – best describes the work included in this payment request.
(7) Identify type of certification – disadvantaged (DBE), minority- (MBE) or women-owned (WBE) – if applicable.
(8) Review your funding agreement to see whether this requirement applies. Federally funded agreements may require the Recipient to search the System for
Award Management (SAM) at
https://www.sam.gov/
for each of their contractors and subcontractors prior to signing contracts with them. This is to ensure the
contractors/subcontractors have not been suspended, debarred or excluded from receiving federal funds. If it applies, send the SAM search page to Ecology for
each contractor and subcontractor. If required, Ecology funding programs may withhold payment for contractor expenses if documentation is not in place.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Contractor
P=Primary
Contractor Address
Contractor
Contractor
C=Construction
Certified
SAM Search Copy
S=Sub
Phone Number
Amount
S=Supplies
DBE=Disadvantaged
Sent to Ecology?
in this Request
SVS=Services
MBE=Minority
Yes or N/A
E=Equipment
WBE=Women
FOR ECOLOGY OFFICE USE ONLY
If you need this document in a format for the visually impaired, call the Fiscal
Project #
A19 Payment Date
Fiscal Month Paid
Administrative Assistant at (360) 407-7054. Persons with hearing loss can call
711 for Washington Relay Service. Persons with a speech disability can call
877-833-6341.
ECY 060-11 Rev. 07/2016