8/10/2019 Prime Contractor Reporting Requirements

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Pa

Bill To: Original Contract Amount:

(issued from Howard County)

Contract No:

For the Period of:

Company Name:

Street Address:

City, ST, Zip:

Phone Number:

Federal EIN No:

Contract

Line # Quantity

Tax - Sales Tax Exemption No. 30001219 Total

PRIME CONTRACTING INVOICING REQUIREMENTS - PART ONE

Office of Purchasing

Howard County, Maryland

From:

Contract Title: (issued from Howard County)

EQUAL BUSINESS OPPORTUNITY (EBO) SUBCONTRACTOR PARTICIPATION

Total Contractor Amount Billed to Date:

INVOICE

The CountysEBO Program requires either an on-site review or documentation to be provided to ensure EBO Subcontracting Participation. To assist in the documentation of your firm

compliance with HowardCountysEBO goals, this form is designed to replace your standard invoice or to accompany your invoice for payment from Howard County, Maryland. Both

need to be completed for payment processing as well as a COPY of this form sent to THE OFFICE OF PURCHASING, 6751 COLUMBIA GATEWAY DR., STE 501, COLUMBIA, MD 2

COORDINATOR.

$0.00

Description of Goods Delivered/Services Performed for Howard County

Tax

Unit Price

Purchase Order No.: (issued from Howard County)

Percent of Work Completed to Date:

(includes this month's bill)

Total Amount Paid to Contractor:

Balance Due to Contractor:

(this month's bill)

$0.00

$0.00

Partial Payment (against referenced PO/SO# above)

Final Payment (against referenced PO/SO# above)

User Agency:

Street Address:

City, ST, Zip:

Phone Number:

PO #

2XXXXXXXX

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0% or

Company Name: (from the EBO Participation Form)

Street Address:

City, ST, Zip:

Phone Number:

Total Amount Paid to EBO Subcontractor:

Total Percent EBO Participation Goal to Date:

Date of

Invoice

EBO Subcontractor

EQUAL BUSINESS OPPORTUNITY (EBO) SUBCONTRACTOR PARTICIPATION

INVOICE

Howard County, Maryland

Office of Purchasing

PRIME CONTRACTING INVOICING REQUIREMENTS - PART TWO

EBO Participa

Total EBO Amount Billed to Dat

(includes this month's bill)

Balance Due to EBO Subcontrac(this month's bill)

Description of Invoice

* REMINDER: EBO SUBCONTRACTORS ALSO REPORT THEIR PARTICIPATION TO THE OFFICE OF

PURCHASING MONTHLY ON THE COUNTY'S STANDARD FORM THAT REQUIRES ITEMIZED INVOICES.

CONTACT THE EQUAL BUSINESS OPPORTUNITY COORDINATOR IN THE OFFICE OF PURCHASING, WITH

EBO PARTICPATION QUESTIONS AT (410) 313-6370.

The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief, the work covered by this invoice has been completed in accor

contact and that the current payment shown herein is now due.

Prime Contractor Authorized Signature Date

Total $0.00

Total Invoice Amount Amount Paid to EBInvoice# from EBO Subcontractor

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Page 3

$0.00

$0.00

$0.00

$0.00

0%

Total

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00$0.00

0.00

participation and

ges of this form

046, ATTN: EBO

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Page 4 of 4

$0.00

$0.00

$0.00

$0.00

0%

ance with the

$0.00

SubContractor