REPORT OF DBE GOAL ACCOMPLISHMENTS

OMB No.: 2105-0510

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  1\. Name of Sponsor                                                                                                                                                                                                                                   **     **                                                                                                                                                                   

  2\. Name of Airport                                                                                                                                                                                                                                   **     **                                                                                                                                                                   

  3\. Name of Preparer                                                                                                                                                                                                                                  **     **                                                              Telephone                                   (**     )     **                                         
                                                                                                                                                                                                                                                                                                                               No.                                                                                                  

  4\. Goal Period:                                                                                                                                                                                                                          From                                      5\. Approved                                                                         **[     ]{.underline}%**                                 
                                                                                                                                                                                                                                            **     **                                 Overall DBE                                                                                                                                   
                                                                                                                                                                                                                                            to                                        Goal                                                                                                                                          
                                                                                                                                                                                                                                            **     **                                                                                                                                                                               

  6\. AIP Project No.(s)                                                                                                                                                                                                                                            **     **                                                                                                                                                       

                                                                                                                                                                                                                                                                                                                                                                                                                                    

                                                                                                                                                                                                                                                                                                                                                **(a)                                                       **(b)                   
                                                                                                                                                                                                                                                                                                                                                Number**                                                    \$Value**               

  7\. Total Prime Contracts Awarded to all                                                                                                                                                                                                                                                                                                      **     **                                                   **     **               
  Contractors...........................                                                                                                                                                                                                                                                                                                                                                                                            

  8\. Total Prime Contracts Awarded to                                                                                                                                                                                                                                                                                                          **     **                                                   **     **               
  DBE's....................................                                                                                                                                                                                                                                                                                                                                                                                         

  9\. Total Subcontracts Awarded to DBE's by                                                                                                                                                                                                                                                                                                    **     **                                                   **     **               
  non-DBE Prime Contractors                                                                                                                                                                                                                                                                                                                                                                                                         

  10\. Total Prime and Subcontracts Awarded                                                                                                                                                                                                                                                                                                                                                                                         
  to DBE's                                                                                                                                                                                                                                                                                                                                                                                                                          

                                                                                                                                                                                            (Sum of Items 8. and                                                                                                                                **     **                                                   **     **               
                                                                                                                                                                                            9.)..........................................                                                                                                                                                                                           

  11\. 10(b) divided by 7(b) =                                                                                                                                                                                                                                                                                                                                                                                                      
  **[     ]{.underline}**% = Actual DBE                                                                                                                                                                                                                                                                                                                                                                                             
  Participation                                                                                                                                                                                                                                                                                                                                                                                                                     

  12\. DBE Prime and Subcontract Awards by                                                                                                                                                                                                                                                                                                                                                                                          
  Type of Work:                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                      **Number**                                                               **\$                                                                 
                                                                                                                                                                                                                                                                                                                                                               Value**                                                              

                                                                                                                                                                                                                                                                                      **Women**                    **Total                                     **Women**                                                **Total     
                                                                                                                                                                                                                                                                                                                   DBE**                                                                                                DBE**       

                                              \(a\)                                               Professional/Consultant Services                                                                                                                                                                                                                                                                                                  

                                                                                                  \(1\)                                         Engineering........................\...                                                                                               **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(2\)                                         Architectural.........................                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(3\)                                         Consultants...........................                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(4\)                                         Testing..............................\...                                                                                             **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(5\)                                         Other..................................                                                                                               **     **                    **     **                                   **     **                                                **     **   

                                              \(b\)                                               Construction                                                                                                                                                                        **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(1\)                                         Grading/Drainage....................                                                                                                  **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(2\)                                         Paving..............................\...                                                                                              **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(3\)                                         Structures/Building...............\...                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(4\)                                         Landscaping..........................                                                                                                 **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(5\)                                         Electrical...........................\...                                                                                             **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(6\)                                         Trucking..............................                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(7\)                                         Painting..............................                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(8\)                                         Fencing...............................                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(9\)                                         Other..................................                                                                                               **     **                    **     **                                   **     **                                                **     **   

                                              \(c\)                                               Supplies                                                                                                                                                                            **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(1\)                                         Electrical.............................                                                                                               **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(2\)                                         Other..................................                                                                                               **     **                    **     **                                   **     **                                                **     **   

                                              \(d\)                                               Equipment                                                                                                                                                                           **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(1\)                                         Leasing...............................                                                                                                **     **                    **     **                                   **     **                                                **     **   

                                                                                                  \(2\)                                         Purchasing........................\...                                                                                                **     **                    **     **                                   **     **                                                **     **   

  13\. DBE Prime and Subcontract Awards by                                                                                                                                                                                                                                                                                                                                                                                          
  Disadvantaged Group:                                                                                                                                                                                                                                                                                                                                                                                                              

                                                                                                                                                                                                                                                                                                   **Number**                                                  **\$                                                                 
                                                                                                                                                                                                                                                                                                                                                               Value**                                                              

                                                                                                                                                                                                                                                                                                                                                                                                                                    

                                                                                                  Black                                                                                                                                                                                            **     **                                                   **     **                                                            
                                                                                                  Americans........................\......                                                                                                                                                                                                                                                                                          

                                                                                                  Hispanic                                                                                                                                                                                         **     **                                                   **     **                                                            
                                                                                                  Americans.........................                                                                                                                                                                                                                                                                                                

                                                                                                  Native                                                                                                                                                                                           **     **                                                   **     **                                                            
                                                                                                  Americans............................                                                                                                                                                                                                                                                                                             

                                                                                                  Asian-Indian                                                                                                                                                                                     **     **                                                   **     **                                                            
                                                                                                  Americans.....................                                                                                                                                                                                                                                                                                                    

                                                                                                  Asian-Pacific                                                                                                                                                                                    **     **                                                   **     **                                                            
                                                                                                  Americans....................                                                                                                                                                                                                                                                                                                     

                                                                                                  Women (that are not included above)...\...                                                                                                                                                       **     **                                                   **     **                                                            

                                                                                                  Other                                                                                                                                                                                            **     **                                                   **     **                                                            
                                                                                                  Disadvantaged.........................                                                                                                                                                                                                                                                                                            

                                              Total                                                                                                                                                                                                                                                **     **                                                   **     **                                                            
                                              DBE..............................................                                                                                                                                                                                                                                                                                                                                     
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+----+--------------------------+-------------+-----------------------+
|    | Office of Management and | *and*       | U.S. DOT/OST/OSDBU,   |
|    | Budget                   |             | S-12                  |
|    |                          |             |                       |
|    | Paperwork Reduction      |             | 400 Seventh Street,   |
|    | Project (2105-0510)      |             | S.W.                  |
|    |                          |             |                       |
|    | Washington, DC 20503     |             | Washington, DC 20590  |
+----+--------------------------+-------------+-----------------------+

DOT Form 4630

DOT Form 4630 must be submitted annually by each sponsor having an
approved DBE program. The form should be submitted to the FAA Regional
Civil Rights Staff with the updated DBE goal information. The form
should reflect contract awards that were made during the period covered
by the sponsor's previously approved overall DBE goal. For some
sponsors, this period may be the Federal fiscal year, while for others,
a different 12-month period. Sponsors of more than one airport should
submit a separate report for each obligated location.

Use this form to report all FAA-assisted contract awards covered by the
DBE program, including professional and consultant services,
construction, supplies, and vehicles and equipment.

**DO NOT REPORT**: (1) FAA-assisted contracts to purchase land; (2)
Non-Federal contracts (those not assisted by the FAA's Airport
Improvement Program (AIP); (3) AIP grant funds used for "force account"
or for other noncontractual work.

While land purchases are not reported, all other contracts let under
land acquisition projects, such as for appraisal and survey, are to be
reported.

When the dollar value of a contract is requested, report the Federal
(FAA) share only; do not include any state or local matching funds.
Round all values to the nearest dollar.

1.  Name of the sponsor

2.  Name of the Airport

3.  Name and telephone number of the person who prepared the report.

4.  The beginning and ending dates of the goal period for which the
    report is submitted.

5.  The sponsor's approved overall DBE goal for the period indicated in
    item 4.

6.  The AIP project number(s) for the prime and subcontracts reported in
    item 7 and item 9.

7.  The total number and dollar value of all prime contracts awarded
    during the goal period.

8.  The number and dollar value of prime contracts reported in item 7
    that were awarded to DBE's.

9.  The total number and dollar value of subcontracts awarded to DBE's
    by non-DBE prime contractors during the goal period. Report only
    those subcontracts actually executed during the goal period,
    regardless of when the prime contract was awarded.

10. This is the sum of the prime and subcontracts to DBE's reported in
    items 8 and 9.

11. Divide the dollar value in 10(b) by the dollar value in 7(b) to
    obtain the actual DBE percentage participation for the goal period.

12. This is a breakout of the prime and subcontracts reported in item 10
    by type of work performed by the DBE's. Indicate number and dollar
    value of awards to women-owned firms under category designated
    "Women". Indicate number and value of awards to all DBE firms,
    including women-owned, under category designated "Total DBE". If the
    contract involves more than one type of work, report only the
    predominant type based on cost.

13. This is a breakout of the prime and subcontract awards to DBE's
    reported in item 10 by the disadvantaged group of the firms' owners.
    The category "Other Disadvantaged" refers to DBE's owned and
    operated by individuals who have been determined by the sponsor on a
    case-by-case basis to be socially and economically disadvantaged.
    The definitions of the disadvantaged groups are found in 49 CFR
    23.62, as amended on October 21, 1987 and May 23, 1988. In the case
    of split ownership by two or more disadvantaged individuals, the DBE
    participation should be reported for the group which owns the
    largest share. If the ownership is equal, the DBE participation
    should be reported for the group which is listed first on the form.