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MBGuidelines 2002 - viii- <br /> APPENDIX E <br /> <br />MBE DOCUMENTATION FOR CONTRACT PAYMENTS <br /> <br />Prime Contractor/Architect: _________________________________________________________ <br /> <br />Address & Phone: _________________________________________________________________ <br /> <br />Project Name: ____________________________________________________________________ <br /> <br />Pay Application #: _________________ Period: ________________________________ <br /> <br />The following is a list of payments made to Minority Business Enterprises on this project for the above- <br />mentioned period. <br /> <br />MBE FIRM NAME * INDICATE <br />TYPE OF <br />MBE <br />AMOUNT <br />PAID <br />THIS MONTH <br />TOTAL <br />PAYMENTS TO <br />DATE <br />TOTAL <br />AMOUNT <br />COMMITTED <br /> <br /> <br /> <br /> <br /> <br /> <br />*Minority categories: Black, African American (B), Hispanic (H), Asian American (A), <br />American Indian (I), Female (F), Social and Economically Disadvantage (D) <br /> <br /> <br />Date: ________________ Approved/Certified By: ___________________________________ <br /> Name <br /> <br /> ___________________________________ <br /> Title <br /> <br /> ___________________________________ <br /> Signature <br /> <br />SUBMIT WITH EACH PAY REQUEST & FINAL PAYMENT <br /> <br />(Revised on 3/14/2003) <br />Docusign Envelope ID: 8DED1454-68D2-4E36-9FC6-E56FF2124E5D