MONTHLY REPORT (PARTS 1A & 1B)
FINAL REPORT (PARTS 1A, 2 & 3)
A
FROM:
TO:
SBE A&E MEASURE
SBE G&S MEASURE
EMAIL
YES
NO
YES
NO
B
MAKE- UP
DATE OF
REQUISITION
(FROM SUB)
AMT REQUISITIONED
TO DATE
LAST PAYMENT
AMT
LAST PAYMENT
DATE
AMT PAID TO DATE
AUTHORIZED SIGNATURE OF PRIME CONSULTANT DATE
SMALL BUSINESS ENTERPRISE - ARCHITECTURAL & ENGINEERING
Was last pmt. Within 2
days of MDC payment to
Prime? Y/N
AGREEMENT AMOUNT
GOAL %
(IF APPLICABLE)
PRINT NAME
TITLE
AMOUNT REQUISITIONED THIS PERIOD
TOTAL AMOUNT REQUISITIONED TO DATE
DATE REQUISITIONED
$
PHONE
USER DEPARTMENT
DEPT. PROJ. MGR/CONTACT PERSON
CHANGE ORDER MODIFICATION AMOUNT
SUBCONSULTANT(s) DATA
NAME OF PRIME CONSULTANT
$
NAME OF FIRMS
DATE OF LAST PMT BY MDC
FACSIMILE
PERCENTAGE OF CONTRACT
COMPLETED
AMOUNT SUB REQUISITIONED
THIS PERIOD
DID LAST PMT EQUAL REQUISITION AMOUNT?
IF NO PLEASE EXPLAIN
$
DESCRIPTION OF WORK
WAS LAST PMT WITHIN 14 DAYS OF PRIME REQUISITION?
SIGNED
AGREEMENT
DATE
SCHEDULED COMPLETION DATE
TELEPHONE
FACSIMILE
PROJECT MANAGER (PRIME CONSULTANT)
ADDITIONAL SERVICES AMOUNT
CONTRACT NO.
This part is to be completed by the Prime Consultant and forwarded to the User Department
MONTHLY UTILIZATION REPORT
PROJECT LOCATION
REPORTING PERIOD CONTRACT NAME
CONTRACT AWARD
START DATE
PARTS 1A & 1B
MEASURE
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.
AGREEMENT AMOUNT
TOTAL AMOUNT PAID BY MDC
ADDRESS
$
LAST PAYMENT BY MIAMI DADE COUNTY (MDC)
TOTALS:
Sworn before me:
This day of
, 20____
M300 C Revised: October 14, 2014
This part is to be completed by the Subconsultants and forwarded to the Prime Consultant.
SIGNATURE OF AFFIANT (PRIME CONSULTANT) TITLE
AUTHORIZED SIGNATURE OF SUBCONSULTANT
AUTHORIZED SIGNATURE OF PROJ MGR/CONTACT PERSON PRINT NAME
DATEPRINTED NAME OF AFFIANT
PART 3
This part is to be executed by the Prime Consultant and forwarded to the User Department.
DATE
COUNTY USE
This part is to be completed by the User Department at the time of Final Requisition to SBD.
NOTARY PUBLIC
TOTAL PAID TO DATE TO
SUBCONSULTANT *
TOTAL SUB REQUISITIONED TO
DATE
SUBCONSULTANTS
NAME OF SUBCONSULTANT
DATE OF WORK COMPLETION
FINAL SUB REQUISITION
AMOUNT
TOTAL AGREEMENT AMOUNT
SMALL BUSINESS ENTERPRISE - ARCHITECTURAL & ENGINEERING
PROMPT
PAYMENT
ISSUES (Y/N)
MONTHLY UTILIZATION REPORT - FINAL ONLY
GOAL (%) IF
APPLICABLE
PART 2
Small Business Enterprise - Architectural & Engineering (SBE-A/E) Program
Instructions for the Monthly Utilization Report (MUR)
Measure: Mark if applicable
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)
PART 1A
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.
SBE A&E Measure: List the Small Business Enterprise Architectural & Engineering Program
goal percentage.
SBE G&S Measure: List the Small Business Enterprise Goods and Services Program goal
percentage.
DEPT. PROJ. MGR/CONTACT PERSON: Contracting Department project manager or contact
person name.
Phone: Contracting Department Project Manager or contact person telephone number
Facsimile: Contracting Department Project Manager or contact person fax number
Prime Consultant: Name of Prime Consultant (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
1
Revised: October 14, 2014
Small Business Enterprise - Architectural & Engineering (SBE-A/E) Program
Instructions for the Monthly Utilization Report (MUR)
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
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 for any undisputed portion of the prime consultant requisition?
Total Amount Paid by MDC: The total amount paid to date by MDC as of the reporting
period
PART 1B
Name of Sub-consultant: The legal name of all subconsultant(s) participating on the project
Goal % (If Applicable): The goal percentage that is being fulfilled by any SBE-A&E sub
consultant. If the percentage is different from the percentage listed on the Letter of Agreement
(LOA) submitted at time of bid or any SBD approved deviation from the LOA, a new LOA must
be submitted to SBD for review and approval.
SBE-A&E Make-up: Check if listed firm is meeting a SBE-A&E make up.
Description of Work: A brief description of the scope of work to be performed by the
subconsultant(s). If the scope of work is different from the scope of work listed on the LOA
submitted at time of bid or any SBD approved deviation from the LOA, a new LOA must be
submitted to SBD for review and approval.
Signed Agreement: Check if Prime has an executed agreement with listed SBE-A&E sub
consultant.
2
Revised: October 14, 2014
Small Business Enterprise - Architectural & Engineering (SBE-A/E) Program
Instructions for the Monthly Utilization Report (MUR)
Agreement Amount: The dollar value of the executed agreement between the prime
consultant and the subconsultant. For CBE subconsultants meeting a goal, the agreement must
agree with the LOA submitted at time of bid or any SBD approved deviation. If not, a new LOA
must be submitted to SBD for review and approval.
Amount SUB Requisitioned this Period: The actual dollar amount requisitioned by the
subconsultant during the listed reporting period.
Date of Requisition (from Sub): The date of the requisition submitted by subconsultant for
payment during the reporting period.
Amount Requisitioned to Date: The total dollar amount requisitioned/billed by the
subconsultant from project inception thru the listed reporting period.
Last Payment Amount: The last dollar amount paid to the subconsultant(s) for the reporting
period.
Last Payment Date: The date of last payment of subconsultant(s) during the reporting
period.
Was last payment within 2 days of MDC payment to prime: “Y” for Yes if payment to
subconsultant(s) was made within 2 days of MDC payment to prime; “N” for No if payment to
subconsultant(s) was not made within 2 days of MDC payment to prime.
AMT Paid to Date: The total amount paid to the listed subconsultants(s) from project
inception thru the listed reporting period
Totals: The total of each column where applicable
Authorized Signature of Prime Consultant: Signature of the person completed the firm
Print Name: Print name
Title: Title
Date: Date form completed
PART 2
Name of Sub Consultant: The legal name of all subconsultant(s) participating on the project.
Authorized Signature of Sub consultant: The legal name of all subconsultant(s)
participating on the project.
Total Agreement Amount: The dollar value of the executed agreement between the prime
consultant and subconsultant including amendments.
3
Revised: October 14, 2014
Small Business Enterprise - Architectural & Engineering (SBE-A/E) Program
Instructions for the Monthly Utilization Report (MUR)
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
subconsultant.
Total Sub Requisitioned to Date: Total amount requisitioned by the subconsultant to date.
Prompt Payment Issues: “Y” if your firm has a prompt payment issue and “N” if the SBE-
A&E sub consultant does not have prompt payment issue
Date of Work Completion: Date the SBE-A&E subconsultant completed the work
Goal % (If Applicable): The goal percentage that is being fulfilled by the SBE-A&E
subconsultant. If the percentage is different from the percentage listed on LOA or any SBD
approved deviation, a new LOA 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
4
Revised: October 14, 2014