DBE Form 3A "Prime Contractor - Final Payment Report" - Oklahoma

What Is DBE Form 3A?

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

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Oklahoma 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 DBE Form 3A by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Transportation.

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Download DBE Form 3A "Prime Contractor - Final Payment Report" - Oklahoma

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OKLAHOMA DEPARTMENT OF TRANSPORTATION
(OFFICE USE ONLY)
PRIME CONTRACTOR
Date Received:
DISADVANTAGED BUSINESS ENTERPRISE
FINAL PAYMENT REPORT
( DBE FORM 3A)
C.C.O.:
If the Prime is a DBE, please add ALL subs (DBE firms & non-DBE firms) below
A.D.M.:
Site Mgr. #:
DBE Goal
PROJECT NUMBER
RESIDENCY
DIVISION
JOBPIECE NUMBER
CONTRACTOR
COUNTY
CONTRACT AMOUNT
CONTRACT GOAL
COMPLETED
FINAL PAYMENT
( Each DBE )
( Each DBE )
NAME OF DBE FIRM
(Retainage Paid)
AMOUNT
( any DBE providing services or supplies on project )
AMOUNT PAID
AMOUNT
DATE
PERCENT
PERCENT
( in $$$ )
( in $$$ )
( in $$$ )
1
2
3
4
5
6
7
8
9
10
TOTALS
Authorized
Subscribed and sworn to before me this
The Contractor certifies that the above amounts
Date
Signature
have been paid to those listed DBE's and that
,
day of
Type/Print
documentation of these payments are available
Name
,Notary Public.
for inspection upon request.
Title
My Commission Expires:
ODOT DBE Form-3A
June 2020
OKLAHOMA DEPARTMENT OF TRANSPORTATION
(OFFICE USE ONLY)
PRIME CONTRACTOR
Date Received:
DISADVANTAGED BUSINESS ENTERPRISE
FINAL PAYMENT REPORT
( DBE FORM 3A)
C.C.O.:
If the Prime is a DBE, please add ALL subs (DBE firms & non-DBE firms) below
A.D.M.:
Site Mgr. #:
DBE Goal
PROJECT NUMBER
RESIDENCY
DIVISION
JOBPIECE NUMBER
CONTRACTOR
COUNTY
CONTRACT AMOUNT
CONTRACT GOAL
COMPLETED
FINAL PAYMENT
( Each DBE )
( Each DBE )
NAME OF DBE FIRM
(Retainage Paid)
AMOUNT
( any DBE providing services or supplies on project )
AMOUNT PAID
AMOUNT
DATE
PERCENT
PERCENT
( in $$$ )
( in $$$ )
( in $$$ )
1
2
3
4
5
6
7
8
9
10
TOTALS
Authorized
Subscribed and sworn to before me this
The Contractor certifies that the above amounts
Date
Signature
have been paid to those listed DBE's and that
,
day of
Type/Print
documentation of these payments are available
Name
,Notary Public.
for inspection upon request.
Title
My Commission Expires:
ODOT DBE Form-3A
June 2020