HomeMy WebLinkAbout1 - Original Submission_ Exhibit B_2022_Performance Reporting Form EXHIBIT B: REPORTING - Performance
2022 Subrecipient Agreement – Sidewalk Infrastructure Safety Repairs
CITY OF BREMERTON
Quarterly Performance Report
BLOCK GRANT PROGRAMS
CITY CONTRACT #: 632130
REPORTING PERIOD:
QTR 1
Jan-Mar, due 4/11
QTR 2
Apr-Jun, due 7/11
QTR 3
Jul-Sep, due 10/10
QTR 4
Oct-Dec, due 1/10
AGENCY: COB/PW&U
PROJECT: Pedestrian Priority Network Infrastructure Improvements
Prepared By / phone # or email: Chris Dimmitt / 360-473-2307
christopher.dimmitt@ci.bremerton.wa.us
Submission Date:
1. Progress Reporting: Describe the progress made to date toward the “Scope of Services” portion of the
Subrecipient Agreement. This includes, but is not limited to, staffing, administrative, programmatic, schedule,
and funding impacts. Be specific. (For housing programs, include the address below.)
Authorized Signature (as set forth in the agreement) Date
Emailed reports represent an electronic signature—please type your name and the date above. You may submit
your quarterly report by e-mail (as a Microsoft Word attachment) to your contact person’s email address.
DocuSign Envelope ID: 8C172022-541E-4924-AA56-23EE3ABFEB73
EXHIBIT B: REPORTING - Performance
2022 Subrecipient Agreement – Sidewalk Infrastructure Safety Repairs
CONTINUE REPORTING BELOW IF YOUR PROJECT INVOLVES CONSTRUCTION:
2. Trades / MWBE Reporting: If your project involves construction, complete the table for each contractor /
subcontractor hired within the reporting period with contracts of $10,000 or more for the types of trades listed
below.
Contractor
(provide name,
mailing address,
zip)
Amount of
Contract
Type of Trade
(see below)
Women-
Owned
Business
(Yes/No)
Contractor or
Subcontractor
racial/ethnic code
(see below)
Section 3
(yes/no;
see below)
Prime
Contractor
Identification
Number (EIN)
Subcontractor
Identification
Number (EIN)
$
$
$
$
Trade Types (1) New Construction: Includes “Ground-Up” construction (2) Education and Training: Please
contact Block Grant Staff for further clarification if you believe that your contract falls under this category (3) Other:
Includes rehab or weatherization (not ‘new’), building permits or architectural drawings supply, professional service,
but not education/training activities. Report each contractor only once. Add each new subcontractor as they are
hired; please also include these contracts in the project progress narrative discussion (above).
Racial Ethnic codes: (1) White Americans (2) Black Americans (3) Native Americans (4) Hispanic Americans (5)
Asian/Pacific Americans (6) Hasidic Jews
All Section 3 covered contracts are for the purpose of ensuring that employment and other economic opportunities
generated by HUD assistance are directed to low- and very low-income persons, particularly persons who are
recipients of HUD assistance for housing. If you are unsure whether Section 3 reporting pertains to you, please
contact your Block Grant contact person.
This data is used for required annual Minority Business Enterprise Reporting - Form HUD2516.
DocuSign Envelope ID: 8C172022-541E-4924-AA56-23EE3ABFEB73