Form 25A 336 PDF Details

A Form 25A 336 is an important document for a business. This form is used to report exempt organization taxable income to the IRS. It's important to understand how this form works and what it means for your business. In this blog post, we'll break down everything you need to know about the Form 25A 336. We'll go over who needs to file it, what information needs to be included, and how the form is used by the IRS. Stay tuned! We'll be sharing more tips on tax season in the coming weeks.

QuestionAnswer
Form NameForm 25A 336
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesfalse, yyyy, form 25 a, DBE

Form Preview Example

MONTLY SUMMARY OF DISADVANTAGED BUSINESS

 

FOR PAYMENTS MADE IN:

 

 

ENTERPRISE PARTICIPATION

MONTH

 

YEAR

Federal-Aid Contracts

 

 

 

 

 

 

 

State of Alaska DOT & PF Civil Rights Office ● 2200 E 42nd Ave. ● Anchorage, AK 99519-6900

 

 

 

Please read instructions before completing this form.

 

 

 

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

 

 

 

4. PRIME CONTRACTOR NAME

 

 

 

 

 

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

 

 

 

 

SUBCONTRACTORS

 

14. FIRM (DBE) NAME

 

15. BID ITEMS PAID

16. AGREED

17. AMOUNT PAID

18. AMOUNT

19. % OF WORK

20. FINAL PAYMENT

 

 

 

 

(LIST SEPARATELY)

PRICE

THIS PERIOD

PAID TO DATE

COMPLETED TO

 

 

 

 

 

 

 

 

 

 

 

DATE

YES

NO

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. NAME OF PERSON PREPARING REPORT

 

11. TITLE

 

 

12. SIGNATURE

 

13. DATE (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 25A-336 (1/2012)

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

 

 

(LIST SEPARATELY)

PRICE

THIS PERIOD

PAID TO DATE

COMPLETED TO

 

 

 

 

 

 

 

 

DATE

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

10. NAME OF PERSON PREPARING REPORT

 

11. TITLE

12. SIGNATURE

13. DATE (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

Form 25A-336 (1/2012)

Page __ of __

MANUFACTURERS (100 % DBE Credit)

21. FIRM (DBE MANUFACTURER) NAME

 

22. PRODUCT

23. AMOUNT PAID

24. AMOUNT PAID TO

20. FINAL PAYMENT

 

 

 

MANUFACTURED

 

THIS PERIOD

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BROKERS (5% DBE Credit for brokerage fee)

 

 

 

 

 

 

25. FIRM (DBE BROKER) NAME

26. PRODUCT/

27. DBE BROKERAGE FEE

28. AMOUNT PAID

29. AMOUNT PAID TO

20. FINAL PAYMENT

 

 

SERVICE

 

 

THIS PERIOD

DATE

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

1

 

 

 

$

-

 

 

 

 

 

 

2

 

 

 

$

-

 

 

 

 

 

 

3

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGULAR DEALERS (60% DBE Credit)

 

 

 

 

 

 

30. FIRM (DBE REGULAR DEALER) NAME

31. MATERIALS

32. AMOUNT PAID THIS

33. AMOUNT PAID

34. AMOUNT PAID TO

20. FINAL PAYMENT

 

 

SUPPLIED

PERIOD

THIS PERIOD (60%)

DATE

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

1

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 25A-336 (1/2012)

Page __ of __

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