Form CEM-2402F "Final Report - Utilization of Disadvantaged Business Enterprises First-Tier Subcontractors" - California

What Is Form CEM-2402F?

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;
  • 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-2402F by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
FINAL REPORT - UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES
For individuals with sensory disabilities, this document is available in alternate
formats. For information, call (916) 445-1233, TTY 711, or write to Records
FIRST-TIER SUBCONTRACTORS
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CEM-2402F (REV 9/2014)
CONTRACT NUMBER
COUNTY
ROUTE
POST MILES
FEDERAL AID PROJECT NUMBER ADMINISTERING AGENCY
CONTRACT COMPLETION DATE
PRIME CONTRACTOR
BUSINESS ADDRESS
ESTIMATED CONTRACT AMOUNT
CONTRACT PAYMENTS
DESCRIPTION OF
DBE
DATE WORK
DATE OF FINAL
ITEM
WORK PERFORMED
COMPANY NAME
CERT.
COMPLETE
PAYMENT
NO.
AND
AND BUSINESS ADDRESS
NUMBER
NON-DBE
DBE
UDBE
MATERIALS PROVIDED
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
ORIGINAL COMMITMENT
TOTAL
$
$
$
DBE/UDBE
List all First Tier Subcontractors, Disadvantaged Business Enterprises (DBEs) and underutilized DBEs (UDBEs) regardless of tier, whether or not the firms were originally listed for goal credit. If actual UDBE utilization (or item
of work) was different than that approved at the time of award, provide comments on the following page after the instructions. List actual amount paid to each entity.
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT
CONTRACTOR REPRESENTATIVE'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
I CERTIFY THAT THE CONTRACTING RECORDS AND ON-SITE PERFORMANCE OF THE DBE(S) HAS BEEN MONITORED
RESIDENT ENGINEER'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
COPY DISTRIBUTION - Caltrans contracts:
Original - District Construction
Copy - Contractor
Copy - Resident Engineer
Copy - OBEO - email
business.support.unit@dot.ca.gov
COPY DISTRIBUTION - Local Agency contracts:
Original - Local Agency Resident Engineer
Copy - District Local Assistance Engineer
Copy - Local Agency file
(submitted with the Report of Expenditures)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
FINAL REPORT - UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES
For individuals with sensory disabilities, this document is available in alternate
formats. For information, call (916) 445-1233, TTY 711, or write to Records
FIRST-TIER SUBCONTRACTORS
and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CEM-2402F (REV 9/2014)
CONTRACT NUMBER
COUNTY
ROUTE
POST MILES
FEDERAL AID PROJECT NUMBER ADMINISTERING AGENCY
CONTRACT COMPLETION DATE
PRIME CONTRACTOR
BUSINESS ADDRESS
ESTIMATED CONTRACT AMOUNT
CONTRACT PAYMENTS
DESCRIPTION OF
DBE
DATE WORK
DATE OF FINAL
ITEM
WORK PERFORMED
COMPANY NAME
CERT.
COMPLETE
PAYMENT
NO.
AND
AND BUSINESS ADDRESS
NUMBER
NON-DBE
DBE
UDBE
MATERIALS PROVIDED
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
ORIGINAL COMMITMENT
TOTAL
$
$
$
DBE/UDBE
List all First Tier Subcontractors, Disadvantaged Business Enterprises (DBEs) and underutilized DBEs (UDBEs) regardless of tier, whether or not the firms were originally listed for goal credit. If actual UDBE utilization (or item
of work) was different than that approved at the time of award, provide comments on the following page after the instructions. List actual amount paid to each entity.
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT
CONTRACTOR REPRESENTATIVE'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
I CERTIFY THAT THE CONTRACTING RECORDS AND ON-SITE PERFORMANCE OF THE DBE(S) HAS BEEN MONITORED
RESIDENT ENGINEER'S SIGNATURE
BUSINESS PHONE NUMBER
DATE
COPY DISTRIBUTION - Caltrans contracts:
Original - District Construction
Copy - Contractor
Copy - Resident Engineer
Copy - OBEO - email
business.support.unit@dot.ca.gov
COPY DISTRIBUTION - Local Agency contracts:
Original - Local Agency Resident Engineer
Copy - District Local Assistance Engineer
Copy - Local Agency file
(submitted with the Report of Expenditures)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
FINAL REPORT - UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES
FIRST-TIER SUBCONTRACTORS
CEM-2402F (REV 9/2014)
Instructions
Contracts advertised on or before June 15, 2012 may contain Underutilized Disadvantaged
Business Enterprise goals (UDBE). Participation for UDBE firms must be reported in the UDBE
column. Contracts advertised after June 15, 2012 may contain Disadvantaged Business Enterprise
(DBE) goals. Participation for contracts advertised after June 15, 2012 must be reported as DBE.
This form has three columns for entering the dollar value for the item(s) of work performed or provided by
the firm. The Non-DBE column is used to enter the dollar value of work performed by first-tier
subcontracting firms who are not certified as a DBE or UDBE.
The DBE column is used to enter the dollar value of work performed by firms that do not fall into the UDBE
category as defined below. The UDBE column is used to enter the dollar value of work performed by firms
who fall under one of the following underutilized groups:
• Black American
• Asian Pacific American
• Native American
• Women
DBE and UDBE prime contractors are required to show the corresponding dollar value of work performed
by their own forces.
If a firm performing work as a DBE or UDBE on the project becomes decertified and still performs work after
the decertification date, enter the total value performed by this firm under the appropriate DBE and UDBE
identification column. If a subcontractor performing work as a non-DBE on the project becomes certified as
a DBE, enter the dollar value of all work performed after certification as a DBE under the appropriate
identification column. Any changes to DBE certification must also be submitted on Form CEM-2403F.
Enter the Date Work Completed as well as the Date of Final Payment (the date when the prime contractor
made the "final payment" to the firm for the portion of work listed as being completed). DBE and UDBE
prime contractors are required to show the date of work performed by their own forces.
Use the comments section to explain any differences in the original commitment and the final utilization of
DBE and UDBE firms.
The contractor and the resident engineer sign and date the form indicating that the information provided is
completed and correct and the DBE paperwork and worksites have been monitored for participation.
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