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August 19. 2015
<br />INSTR1-C TIONS FOR COMPLETING Tt18I iiFuRNI RF:PQRT O DIMAWARIf4` -OMNIIT!►tF�"fS:►�o PAN �lr:� r5
<br />1. Ind'.'11c11117IXlI4peraurs Adoitni.rrai.un(,fL11 ths[ prWir1c5 y+nr .4111. F•.m. x11. total tnw.bv of o n1c Cnimaats aw.nS:.l n1 KIM.
<br />F'edrral ilnaneial assistance. If asxr tatace comes front more than ,.m spt•cify the mum--gt awarded to Dinh through Gate Neutral metltod.s
<br />flA, ust scparAc re,tlnmg Tunis,, fOr each tat. L you ate an FTA Xltl Iifall ime.�totractaau�rsiedrhear.•I, xt.ncprri�td.cutiulate thn
<br />rec•ipir.Mt. rndrealc your Vcothrr Number ,n lie spvec f.-rrsided. i to Dill`s Dtvide the dollar amoum in item 81[•1 by
<br />If you roc an FAA reo rivent. rndreata ktx: relcvrnt AIP Niimbraa
<br />cm ar rd by this n'ptnt. 11 nrore than six. attach a septi u. sited.
<br />l `p,,�iy the Federal liwal year lix 0evobcr W"' i ember 101 in
<br />which am eexered repaning period rails.
<br />d Sate the dare r+f sufuntssitxt of tints tryx+rt
<br />S (hctk the' .tpp,,giriai, bo, That indicalM the r•parung Nrrrxl'hot
<br />the diva pto, 0-1 in FILMS report coven If this repttrt r, dor June 1.
<br />dna should caser Och*Cr -M-1`011131. If this k4X%is dui DrcCmarr
<br />1, date should cov:r Apnt Stplember iii.
<br />5. !lame of the tecipient.
<br />7. State vratr *must DHE soallsi rstablis)xd rot the Federal rascal
<br />Ye" of Ihrs report to b. uhmittcj to and apprt+vcd by the rekvsat OA.
<br />Your overall Goal is to be mpNW as wxli as d+e breakdown for
<br />specific Race Co cievs and Race Neutral [lets (btib of which
<br />inclodc ponder xmsciva+ aculral goals). The ROW Ctotseirlua Qx Pl
<br />portion should be based on program.- shot focus an and provide b;nerim
<br />only for Ms. The uta of eoptritct goals is n primary cxamplc of a
<br />race aonFcious nsruure. The Race Neutral Goal portion should include
<br />programs that, while bnacfi/ing DBEs,. pre not solely fatumd on DBF
<br />Brom. ror otampls. a small bu5imss outresuh ptOMM, lechaical
<br />assiftanea. amid prompt payment Clauses Can temp a Wide variety of
<br />buincssca ar, addiltan to helping DDE Gams.
<br />8-4. 'iiia arricohia in items INA) 401 should incl.tde alk Vnw of print
<br />contracts anardcrl and all types orsubcantracu awarr[ed or conrnti led,
<br />including. luafcssiotul OF consulirutt scrvicmt' ConsIrWior, purcltarc of
<br />raaterj Is C. supplies, lease or purchase or ,quipm,"t and any water
<br />tapes or sen ices. All Oullar amomink am CJ relict[ only the rcderal
<br />share of such constricts, and slwti d be rounded to the roared dollar.
<br />Xj A)- Prustde the t1ll8L!�Ui Par all pnnre ctrntrmx is assisted
<br />wail OUT funds that tame awarded dunng this reporting Fnrio 1.
<br />fi(13). Pruvidc thz L&LM lI I"A of ail prime rtutmxls assisted with
<br />rx'Tr I'tntds Ibat aero awarded during this reporting period.
<br />RC) From tax total dollar amount awarded in &fain );(Ai, peuside'he
<br />jr,Jlar m, g tri awarded to cenitf ed UBE% dormp this reporting pituita
<br />SID) rywri the total mother of prsme conimuls awstsled in urnt 81131.
<br />:pm;if} the ItF'Itll'!.'L uw'arded to certified I>BIia during %hie repotting
<br />lxYiod.
<br />K(f). From Ibe total dollar_ awarded in X(l`l, prt„idc miler t
<br />liM awarded to DBEs though IM use of Race Conscious txetliDik
<br />ret: rest dcliritron of Race t'onsc.arz trial in ilun I and the
<br />esptanation in hem M n€pn/jeer rapes to include in your calculation.
<br />K1F7. Fttnn tln: total number or prima con nt:ts awarded in WD),
<br />specify %he Illi awarded to DHF& Ihrarigh Race Cawsclaus
<br />me(hoth
<br />Yiti) Frrxit the total dollar amount awarded in item NIC[, protide the
<br />JN!H-IatL11D1 awarded w cCrtifred DRF.tt through the use of Rx -c
<br />?neutral ntetlwds. Ste mite definition of Rue Neutral Coal in iters ?
<br />and mbe explanation in iters X of project tYPvo'o include.
<br />�.LtCi7Wt & 8A ag
<br />1v: dollar amt+rtni in item MAI to deme this perccntayc. Round
<br />percentagc r0 the nearcbt tenth
<br />XA!•olI► item, 41A14pi ars ilcrivcd in thu vattle way ax Tram: 817 Ri•
<br />1t(Im, except that these calculations a'wuld be hatted an subcontracts
<br />rather thin puma conlracois i'nlilte prime con rash, which ntay only
<br />be awankd, snhcittttracrs may he either awarded or committed.
<br />liXAl•11117- Fur all I)BE% axardcd print ewttraM and awarrlcd cr
<br />conmatmod sabevstrarls as indicated to l+[t l [Dl and vtCMDI, break:
<br />the data dow,t fi rihsr by total dollar amount as well as the mxitber of
<br />all co alraer, going to tach ethnic group as sell a, to nna-miaoruy
<br />women. "rite "Ultter' catcronV iaclud&;1 those 1D$115 Who arc not
<br />ntemhm orilx prcalnnptivcka ms ulvania cd groups alrtmlg listed. but
<br />who are determined cligihl, for the PAI: program on an m hvudaal
<br />b"- Ic g a (,'aucasian mate with a disabdny). the M W -S value in
<br />llltlll should equal pre sum of N(Cl plus 9(Ch area similarly, the
<br />TOTALS vahto in 114H) should Oval The into of 8(D) paw FiW
<br />t'olumn I should only be filled our it this rcpon is dnc on Dstembcr 1.
<br />as indicsicd in item 3. 'ane valttra for ibis rolumn are derived by
<br />adding Ike valeft tet1k."ed in rtdtimn iH in your first report with the
<br />whirs rgkMd in Ihfs World repast
<br />13EAa. Provide the molal number of primo cuatrocns vOMPICltd during
<br />this mpnring pernxl that had #tae Corn immm; grab. Race 170wiara
<br />s 1dMis ire kbM with cuntraq gunk Or rxrlher :ace cumciaes
<br />Ift"ur0.
<br />I:EEIi Prrnid: the tarsi rbdu value of pont contracts cortgtlged dris
<br />repuning period Mat hod rare conwiaus goals.
<br />121(7protidc the 10141 dol".ar amount of DOE padrerpal:.m 00 all
<br />Race ConsLims pnu r .ot:uecks cum illtmed this M101". period that
<br />was necay,ary in reed the contract gm'ie on tbem. Thi. appl e ti Only l0
<br />Race Coercion, psirna eontraus.
<br />1:(DI pmule the actual total DBE rrarticipation in+tothrs on the race
<br />conscious prime contracts rompleted this reporting period.
<br />12fE1. of all thv prime cantrmu eonrplcred This reltoniay period.
<br />calcutatt ibe prnenuse of DOE panirinntiun Divide the atrial MIM
<br />dollar anwimi in 121D1 by Ike total do11ar value provided in MR) to
<br />c irive ibis peracalablc. Round to 11W reara4i. [tab.
<br />I i(AH 111). Items I I(A).13(E:) am deri+ed in the same mnmxr a:
<br />items 12fA1.12f1sl. ex4vPt th_1c tiFft-N slioukl be bared tin Race
<br />Neutral prime contacts (I.e. Vinee w•rtli no rate conscious truasums).
<br />J4fAE•141E)• C-alculpte Ilse totab for each coltuna by adding the race
<br />tarseious and noutrol figures provided in each row above.
<br />I$. Name orthe Authorized Reprem"Wive prcpatiag this form.
<br />! t<. 5ignantre of Thr Awbori�ed Rep�cscmatisr.
<br />17. Phone number orthe Atithurimi! Mpiucatruve.
<br />It% pax number of die Authorized Representative.
<br />*,S,Ibgdt aver CaraplMed -part ra your Tteomrt rr Dts tan t1111ee.
<br />Page 43 of 43
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