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E. Prior to the award of this contract, the contractor will be required to provide to the Principal Representative a list of M/WBE <br />enterprises, stipulating the dollar amount of each subcontract or supplier of materials on page 2 of this Minority and Women <br />Business Enterprises Participation Report. <br />F. The contractor will retain records and documents showing the level of participation for two years following completion of this <br />contract. These records and documents, or copies thereof, will be made available at reasonable times and places for <br />inspection by an authorized representative of the Principal Representative, or its designated representatives, and will be <br />submitted to such representatives upon written request. <br />MBE: Yes ❑ WBE: Yes ❑ <br />No No ,® <br />Total Contract Amount: $ Li 9 10 10 <br />Name and Address of M/WBE MBE WBE Type of Work <br />Subcontractors and /or Suppliers and /or Contract Contract <br />Self- Performed Work by M/WBE Primes* Amounts Amounts <br />*Indicate ethnicity based on Paragraph III. A. above. <br />Total MBE Contracts: $ O <br />Total WBE Contracts: $ Q <br />Total MBE %: Q <br />Total WBE %: 0 <br />State Form MWBE -1 Page 2 of 2 <br />Rev. 1012008 <br />