MONTHLY REPORT (PARTS 1A & 1B) FINAL REPORT (PARTS 1A, 2 & 3)
CBE MEASURE
A
FROM:
TO:
CBE MEASURE:
EMAIL
YES
TOTAL AMOUNT REQUISITIONED TO DATE
NO
FACSIMILE
DID LAST PMT EQUAL REQUISITION AMOUNT?DATE REQUISITIONED
$
$
PHONE
USER DEPARTMENT
DEPT. PROJ. MGR/CONTACT PERSON
CONTRACT NAME
NAME OF FIRM
PERCENTAGE OF CONTRACT
COMPLETED
CHANGE ORDER MODIFICATION AMOUNT ADDITIONAL SERVICES AMOUNT
FACSIMILE
PROJECT MANAGER (PRIME CONTR.)
CONTRACT AWARD
AGREEMENT AMOUNTDATE
SCHEDULED COMPLETION DATE
This report is required by Miami Dade County. Failure to comply may result in MDC commencing proceedings to impose sanctions on the successful bidder, in addition to pursuing any other available legal remedy. Sanctions may include the suspension of any
payment or part thereof, termination or cancellation of the contract, and the denial to participate in any further contracts awarded by MDC. Pursuant to Florida Statutes (F.S.) 837.06, whoever knowingly makes a false statement in writing with the intent to mislead a
public servant in the performance of their official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in F.S. 755.082, F.S. 755.083 and F.S. 755.084.
ARCHITECTURE & ENGINEERING UTILIZATION REPORT
PROJECT LOCATION
CONTRACT NO.
TELEPHONE
ADDRESS
This part is to be completed by the Prime Consultant and forwarded to the User Department
PARTS 1A & 1B
START DATE
REPORTING PERIOD
AMOUNT REQUISITIONED THIS PERIOD
PRIME CONSULTANT
LAST PAYMENT BY MIAMI DADE COUNTY (MDC)
TOTAL AMOUNT PAID BY MDC
YES
NO
B
DATE OF
REQUISITION
(FROM SUB)
AMT REQUISITIONED
TO DATE
LAST PAYMENT
AMT
LAST PAYMENT
DATE
AMT PAID TO DATE
A
MOUNT SUB REQUISITIONED
THIS PERIOD
IF NO PLEASE EXPLAIN
WAS LAST PMT WITHIN 14 DAYS OF PRIME REQUISITION?$
AGREEMENT AMOUNT
$
PRINT NAME TITLE
SUBCONSULTANTS' DATA
Was last pmt. Within 2
days of MDC payment to
Prime? Y/N
DATE OF LAST PMT BY MDC
AUTHORIZED SIGNATURE OF PRIME CONSULTANT DATE
NAME OF SUBCONSULTANT
GOAL %
(IF APPLICABLE)
CBE
MAKE-UP
SIGNED
AGREEMENT
DESCRIPTION OF WORK
CBE Monthly Utilization Report
Revised : 03/17/2006
AUTHORIZED SIGNATURE OF SUBCONSULTANT
This part is to be completed by the Sub consultants and forwarded to the Prime Consultant.
ARCHITECTURE & ENGINEERING UTILIZATION REPORT - FINAL ONLY
SUBCONSULTANTS
NAME OF SUBCONSULTANT
PART 2
TOTAL AGREEMENT AMOUNT
FINAL SUB REQUISITION
AMOUNT
TOTAL PAID TO DATE TO
SUBCONSULTANT
TOTAL SUB REQUISITIONED TO
DATE
DATE OF WORK COMPLETION
GOAL (%) IF
APPLICABLE
PROMPT
PAYMENT
ISSUES (Y/N)
Sworn before me:
This day of
, 2002
DATE
COUNTY USE
This part is to be completed by the User Department at the time of Final Requisition to DBD.
AUTHORIZED SIGNATURE OF PROJ MGR/CONTACT PERSON PRINT NAME
DATEPRINTED NAME OF AFFIANT
PART 3
SIGNATURE OF AFFIANT (PRIME CONSULTANT) TITLE
NOTARY PUBLIC
This part is to be executed by the Prime Consultant and forwarded to the User Department.
CBE Monthly Utilization Report
Revised : 03/17/2006
Department of Small Business Development
Community Business Enterprise (CBE) Program
Instructions for the Monthly Utilization Report (MUR)
1
Revised:June2011
Monthly Report (PARTS 1A & 1B): Mark if applicable
Final Report (PARTS 1A, 2 & 3): Mark if applicable (Final MUR should be submitted upon
the completion and final payment of project)
CBE Measure: Mark if applicable
Reporting Period: The period for which the MUR payment information is being submitted.
The MUR is due on the 10
th
of every month; as a result, the reporting period will be for the
prior month.
Contract Name: The assigned project name as it is identified in the contract documents
Contract NO.: The assigned project number as it is identified in the contract documents
Project Location: The address or descriptive location of project work site
Start Date: Date of work commencement
User Department: e.g. GSA, Parks, etc.
DEPT. PROJ. MGR/CONTACT PERSON: Contracting Department project manager or contact
person name
Phone: Project manager or contact person telephone number
Facsimile: Project manager or contact person fax number
Prime Consultant: Name of Awardee, address and telephone, fax, email and project manager
name
Contract Award: Date of contract award and agreement amount
Change Order Modification Amount: The total amount of all approved change orders thru
the listed reporting period.
Additional Services Amount: Any dollar amount added for additional services
Scheduled Completion Date: The anticipated date the contract will be completed
Percentage of Contract Completed: The proportion of work that has been completed for
this project stated as a percentage
Amount Requisitioned this Period: The dollar amount billed/requisitioned to MDC for work
performed during the listed reporting period
Department of Small Business Development
Community Business Enterprise (CBE) Program
Instructions for the Monthly Utilization Report (MUR)
2
Revised:June2011
Date Requisitioned: The date the requisitioned amount was submitted to MDC
Did last MDC Payment Equal Requisition Amount: If requisition was paid in full check
“YES”; if requisition amount was not paid in full check “NO” and explain reasons for payment
difference in space provided
Total Amount Requisitioned to Date: The total dollar amount requisitioned from project
inception through the reporting period
Last Payment by Miami Dade County (MDC): The last dollar amount paid to Prime by MDC
for reporting period
Date of Last Payment by MDC: The date of the last payment by MDC for the reporting
period
Was last MDC payment within 14 days of Prime’s requisition: Check YES if payment by
MDC was made within 14 days of prime’s requisition; Check NO if payment by MDC was not
made within 14 days of prime’s undisputed requisition.
Total Amount Paid by MDC: The total amount paid to date by MDC as of the reporting
period
Name of Sub-consultant: The legal name of all sub-consultant(s) meeting a goal listed on
the Prime's Letter of Agreement (s) approved by SBD.
Goal % (If Applicable): The goal percentage that is being fulfilled by the CBE sub-
consultant. If the percentages differ from the percentage listed on the SBD approved LOI, a
new LOI must be submitted to SBD for review and approval.
CBE Make-up: Check if listed firm is meeting a CBE make up dollar amount.
Description of Work: A brief description of the scope of work to be performed by CBE sub-
consultant(s). If the scope of work is different from the percentage listed on the SBD approved
LOI, a new LOI must be submitted to SBD for review and approval.
Signed Agreement: Check if Prime has an executed agreement with CSBE sub-consultant
listed.
Agreement Amount: The dollar value of the executed agreement between the prime
consultant and CBE sub consultant. If the agreement amount is different from the value of the
SBD approved LOI, a new LOI must be submitted to SBD for review and approval.
Amount SUB Requisitioned this Period: Actual dollar amount requisitioned by the CBE sub-
consultant during the listed reporting period
Department of Small Business Development
Community Business Enterprise (CBE) Program
Instructions for the Monthly Utilization Report (MUR)
3
Revised:June2011
Date of Requisition (from Sub): The date of the requisition submitted by CBE sub
consultant for payment during the reporting period.
Amount Requisitioned to Date: The total dollar amount requisitioned/billed by the listed
CBE firm from project inception thru the listed reporting period.
Last Payment: The last dollar amount paid to CBE sub-consultant(s) for the reporting period
Last Payment Date: The date of last payment of CBE sub consultant(s) for the reporting
period
Was last payment within 2 days of MDC payment to prime: “Y” for Yes if payment to
sub consultant(s) was made within 2 days of MDC payment to prime; “N” for No if payment to
sub consultant(s) was not made within 2 days of MDC payment to prime
AMT Paid to Date: The total amount paid to the listed CBE subcontractor(s) from project
inception thru the listed reporting period
Authorized Signature of Prime Consultant: Signature of the person completed the firm
Print Name: Print name
Title: Title
Date: Date form completed
Total: The total of each column where applicable
PART 2
Name of Sub consultant: The legal name of all sub consultant(s) meeting a goal listed on the
Prime's Letter of Agreement(s) approved by SBD.
Authorized Signature of Sub consultant: The legal name of all sub consultant(s) meeting a
goal listed on the Prime's Letter of Agreement(s) approved by SBD.
Total Agreement Amount: The dollar value of the executed agreement between the prime
consultant and CBE sub consultant including amendments.
Final SUB Requisition Amount: Actual dollar amount of final requisitioned to the prime
consultant
Total Paid to Date to Sub consultant: The total amount paid by the Prime Consultant to the
CBE sub consultant.
Department of Small Business Development
Community Business Enterprise (CBE) Program
Instructions for the Monthly Utilization Report (MUR)
4
Revised:June2011
Total Sub Requisitioned to Date: Total amount requisitioned by the CBE sub consultant to
date
Prompt Payment Issues: “Y” if your firm has a prompt payment issue and “N” if the CBE
sub consultant does not have prompt payment issue
Date of Work Completion: Date the CBE sub consultant completed the work
Goal % (If Applicable): The goal percentage that is being fulfilled by the CBE sub consultant.
If the percentages differ from the percentage listed on the SBD approved LOI, a new LOI must
be submitted to SBD for review and approval.
PART 3
Executed by: The signature and printed name of the CEO, President, or an officer of the
company, legally authorized to represent the prime consultant
Sworn before me: Notary Information
COUNTY USE
Authorized Signature of PROJ.MGR/Contract Person: Signature of the contracting
department project manager or contact person.
Print Name: Print the name of the contracting department project manager or contact person.
DATE: Title
