In the realm of Federal-Aid Contracts, ensuring the inclusion and fair payment of disadvantaged business enterprises (DBEs) is not only a matter of ethical practices but also a regulatory requirement. The 25A 336 form, specifically designed for reporting the monthly summary of disadvantaged business enterprise participation, serves as a critical tool in this endeavor. This comprehensive form, utilized by contractors under the jurisdiction of the State of Alaska Department of Transportation and Public Facilities (DOT & PF) Civil Rights Office, outlines detailed information including the project name and number, prime contractor name, and a series of disclosures regarding payments made to DBEs. Importantly, it requires submission by the 15th of the month following the reporting month, ensuring timely and accurate accounting of DBE participation. By affirming the accuracy and completeness of the submitted information, the form helps maintain transparency and integrity within the procurement process. Moreover, it includes sections dedicated to subcontractors, manufacturers, brokers, and regular dealers, categorizing payment details that give a window into the extent of DBE involvement within projects. Not just a paperwork exercise, the 25A 336 form represents a crucial step towards promoting diversity and fairness in the competitive landscape of government contracts.
| Question | Answer |
|---|---|
| Form Name | Form 25A 336 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | false, yyyy, form 25 a, DBE |
MONTLY SUMMARY OF DISADVANTAGED BUSINESS |
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FOR PAYMENTS MADE IN: |
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ENTERPRISE PARTICIPATION |
MONTH |
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YEAR |
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State of Alaska DOT & PF Civil Rights Office ● 2200 E 42nd Ave. ● Anchorage, AK |
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Please read instructions before completing this form. |
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Submit this form to the CRO by the 15th of he month following the reporting month. (i.e.: Work performed in January will be paid in February; the summary report for January must be submitted to the CRO by March 15).
1. PROJECT NAME |
Project Number |
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4. PRIME CONTRACTOR NAME |
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The undersigned affirms that the information that they are providing to the Alaska Department of Transportation and Public Facilities, Civil Rights Office is accurate and complete to the best of their knowledge. Further, the undersigned authorizes the Alaska Department of Transportation and Public Facilities, Civil Rights Office to verify the accuracy of the information provided. Please note that the Alaska Department of Transportation and Public Facilities, Civil Rights Office, is required to report to the Department of Transportation any false, fraudulent, or dishonest conduct in connection with the program, so that DOT can take steps (e.g. referral to the Department of Justice for criminal prosecution, referral to the DOT Inspector General, action under suspension and debarment or Program Fraud and Civil Penalties rules) provided in §26.109. The Alaska Department of Transportation and Public Facilities, Civil Rights Office, will consider similar action under our own legal authorities, including responsibility determinations in future contracts.
10. NAME OF PERSON PREPARING REPORT |
11. TITLE |
12. SIGNATURE |
13. DATE |
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SUBCONTRACTORS
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14. FIRM (DBE) NAME |
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15. BID ITEMS PAID |
16. AGREED |
17. AMOUNT PAID |
18. AMOUNT |
19. % OF WORK |
20. FINAL PAYMENT |
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(LIST SEPARATELY) |
PRICE |
THIS PERIOD |
PAID TO DATE |
COMPLETED TO |
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If more spaces are required, use as many copies of the second page of this form as necessary. The contractor must sign each sheet to certify its content and completion. |
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Are additional pages attached? |
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10. NAME OF PERSON PREPARING REPORT |
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11. TITLE |
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12. SIGNATURE |
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13. DATE (mm/dd/yyyy) |
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Form |
Page __ of __ |
SUBCONTRACTORS CONTINUED
14. FIRM (DBE) NAME |
15. BID ITEMS PAID |
16. AGREED |
17. AMOUNT PAID |
18. AMOUNT |
19. % OF WORK |
20. FINAL PAYMENT |
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(LIST SEPARATELY) |
PRICE |
THIS PERIOD |
PAID TO DATE |
COMPLETED TO |
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DATE |
YES |
NO |
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If more spaces are required, use as many copies of the second page of this form as necessary. The contractor must sign each sheet to certify its content and completion. |
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Are additional pages attached? |
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NO |
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10. NAME OF PERSON PREPARING REPORT |
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11. TITLE |
12. SIGNATURE |
13. DATE (mm/dd/yyyy) |
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Form |
Page __ of __ |
MANUFACTURERS (100 % DBE Credit)
21. FIRM (DBE MANUFACTURER) NAME |
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22. PRODUCT |
23. AMOUNT PAID |
24. AMOUNT PAID TO |
20. FINAL PAYMENT |
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MANUFACTURED |
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THIS PERIOD |
DATE |
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BROKERS (5% DBE Credit for brokerage fee) |
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25. FIRM (DBE BROKER) NAME |
26. PRODUCT/ |
27. DBE BROKERAGE FEE |
28. AMOUNT PAID |
29. AMOUNT PAID TO |
20. FINAL PAYMENT |
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SERVICE |
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THIS PERIOD |
DATE |
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YES |
NO |
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1 |
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$ |
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$ |
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REGULAR DEALERS (60% DBE Credit) |
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30. FIRM (DBE REGULAR DEALER) NAME |
31. MATERIALS |
32. AMOUNT PAID THIS |
33. AMOUNT PAID |
34. AMOUNT PAID TO |
20. FINAL PAYMENT |
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SUPPLIED |
PERIOD |
THIS PERIOD (60%) |
DATE |
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YES |
NO |
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1 |
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$ |
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2 |
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If more spaces are required, use as many copies of the second page of this form as necessary. The contractor must sign each sheet to certify its content and completion.
Are additional pages attached?
YES
NO
Form |
Page __ of __ |