Dasny, a government contractor, recently released their annual compliance report. The report details various compliance issues, such as affirmative action and anti-discrimination policies. This report is an important resource for companies that are looking to do business with Dasny. It is also a valuable tool for understanding how Dasny conducts business and ensures that all company policies are in compliance with state and federal law.
| Question | Answer |
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| Form Name | Dasny Compliance Report Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | dasny compliance report form, dasny exhibit e payment requisition and dual certification form, example of annual compliance report, dasny payment requisition form and dual certification |
COMPLIANCE REPORT
PRIME CONTRACTOR / CONSULTANT / VENDOR INFORMATION
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MBE/WBE/SDVOB - PAYMENTS
MBE PAYMENT INFORMATION
Instructions: In the appropriate section, please list each NYS Certified MBE/WBE/SDVOB subcontractor or supplier being utilized. All subcontractors and suppliers utilized must be listed regardless of the award amount or the payment being made. Compliance Report Instructions click HERE
Check if no MBE subcontractors or suppliers are being utilized in this section
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MBE SUBTOTAL:
WBE PAYMENT INFORMATION
Check if no WBE subcontractors or suppliers are being utilized in this section
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WBE SUBTOTAL:
SDVOB PAYMENT INFORMATION Check if no SDVOB subcontractors or suppliers are being utilized in this section
DASNY Compliance Report Form (05/26/16) |
Page 1 of 3 |
COMPLIANCE REPORT
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SDVOB Company Information |
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DASNY Compliance Report Form (05/26/16) |
Page 2 of 3 |
COMPLIANCE CERTIFICATION*
hereby certifies that for the current payment period: (i) the information in this report regarding MBE/WBE/SDVOB participation on the contract is true and accurate; (ii) the MBE/WBE/SDVOB subcontractors and vendors listed in this report have performed a commercially useful function on the project and have not, other than as allowed in the approved Utilization Plan, subcontracted their assigned scope of work to a
Principal or Officer (print name and title) |
Signature |
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Subscribed and sworn to before me in the State of _________________________ |
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County of ___________________ this _____ day of ________________ , 20____ |
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Notary Public: |
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ID No.: ______________________________ |
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My Commission Expires: ________________ |
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*False statements, information or data submitted on or with Application for Payment, may result in one or more of the following actions: Termination of Contract for cause; disapproval of future bids, contracts, or subcontracts; withholding of final payments on the contract; and civil and/or criminal prosecution.
DASNY's review of this report does not relieve the Contractor of its obligation to provide a true and accurate report and strictly comply with its approved Utilization Plan and Contract General Conditions requirements.
Reviewed by Design/Const. Phase Manager (print name and title) |
Signature |
Date |
DASNY Compliance Report Form (05/26/16) |
Page 3 of 3 |