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__ <br />. I <br />•I~' ~ <br />~. ~ ~ ~ <br />E. Prior to the award of this contract, the contra~tor will be required to provide to the Principal Representative a list of M/WBE <br />ente~~rises, stipulating the dollar amount of each subcontract or supplier of materials on page 2 nf this Minority and Women <br />Business Enterp~rises Participation Report. <br />F. The contractor N~ill retain records and documents showing the level of participation for two years foliowing completion of this <br />contract. Thes~3 records and documents, or copies thereof, will be made available at reasonable times ar~d places for <br />inspection by an authorized representative af the Principal Representative, or its designated representatives, and wiil be <br />submitted to suc,h representativ~s upon writt~n request. <br />MBE: Yes I] WBE: Yes ^ <br />No ~~ No ~ <br />Total Contract Amount: $ <br />Name and A~ddress oiF MNVBE MBE WBE ~'ype of WorM; <br />Subcontractors and/c~r Supp9iers a~nd/or Contract Contract <br />Self-Perform~ed Work b MNVBE Primes* Amounts Amounts <br />*Indicate ethn~icity base~d on Paragraph III. A. above. <br />Total MBE Ccmtracts: $ <br />Total WBE Contracts: $ , <br />Total MBE %: <br />Total WBE %: <br />~ ~ <br />State Form NNVBIE-1 I Page 2 of 2 <br />Rev. 9/2006 <br />