OMB CONTROL NO. 2090-0030

APPROVED: 05/01/2008

APPROVAL EXPIRES: 01/31/2011

**U.S. ENVIRONMENTAL PROTECTION AGENCY**

**MBE/WBE UTILIZATION UNDER FEDERAL GRANTS, COOPERATIVE**

**AGREEMENTS, AND INTERAGENCY AGREEMENTS**

> PART 1. (Reports are required even if no procurements are made during
> the reporting period.)

+--------------------+-----+-----+---------------------+--------------+
| 1A. FEDERAL FISCAL | 1B. |     |                     |              |
| YEAR               | REP |     |                     |              |
|                    | ORT |     |                     |              |
| 200\_\_\_\_\_\_\_  | ING |     |                     |              |
|                    | PER |     |                     |              |
|                    | IOD |     |                     |              |
|                    | (Ch |     |                     |              |
|                    | eck |     |                     |              |
|                    | ALL |     |                     |              |
|                    | ap  |     |                     |              |
|                    | pro |     |                     |              |
|                    | pri |     |                     |              |
|                    | ate |     |                     |              |
|                    | box |     |                     |              |
|                    | es) |     |                     |              |
|                    |     |     |                     |              |
|                    | 1^  |     |                     |              |
|                    | st^ |     |                     |              |
|                    | (Oc |     |                     |              |
|                    | t-D |     |                     |              |
|                    | ec) |     |                     |              |
|                    | 2^  |     |                     |              |
|                    | nd^ |     |                     |              |
|                    | (Ja |     |                     |              |
|                    | n-M |     |                     |              |
|                    | ar) |     |                     |              |
|                    | 3^  |     |                     |              |
|                    | rd^ |     |                     |              |
|                    | (Ap |     |                     |              |
|                    | r-J |     |                     |              |
|                    | un) |     |                     |              |
|                    | 4^  |     |                     |              |
|                    | th^ |     |                     |              |
|                    | (Ju |     |                     |              |
|                    | l-S |     |                     |              |
|                    | ep) |     |                     |              |
|                    | Ann |     |                     |              |
|                    | ual |     |                     |              |
|                    |     |     |                     |              |
|                    | Ch  |     |                     |              |
|                    | eck |     |                     |              |
|                    | if  |     |                     |              |
|                    | t   |     |                     |              |
|                    | his |     |                     |              |
|                    | is  |     |                     |              |
|                    | the |     |                     |              |
|                    | l   |     |                     |              |
|                    | ast |     |                     |              |
|                    | rep |     |                     |              |
|                    | ort |     |                     |              |
|                    | for |     |                     |              |
|                    | the |     |                     |              |
|                    | p   |     |                     |              |
|                    | roj |     |                     |              |
|                    | ect |     |                     |              |
|                    | (P  |     |                     |              |
|                    | roj |     |                     |              |
|                    | ect |     |                     |              |
|                    | co  |     |                     |              |
|                    | mpl |     |                     |              |
|                    | ete |     |                     |              |
|                    | d). |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 1C. REVISION OF A  | B   |     |                     |              |
| PRIOR REPORT? Y or | RIE |     |                     |              |
| N                  | FLY |     |                     |              |
|                    | DE  |     |                     |              |
| Year:              | SCR |     |                     |              |
| \_\_\_\_\_\_\_\_\_ | IBE |     |                     |              |
|                    | THE |     |                     |              |
| Quarter:           | REV |     |                     |              |
| \_\_\_\_\_\_\_\_\_ | ISI |     |                     |              |
|                    | ONS |     |                     |              |
|                    | YOU |     |                     |              |
|                    | ARE |     |                     |              |
|                    | M   |     |                     |              |
|                    | AKI |     |                     |              |
|                    | NG: |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 2A. EPA FINANCIAL  |     |     | 3A. RECIPIENT NAME  |              |
| ASSISTANCE OFFICE  |     |     | AND ADDRESS         |              |
| ADDRESS            |     |     |                     |              |
|                    |     |     |                     |              |
| ( ATTN: DBE        |     |     |                     |              |
| Coordinator)       |     |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 2B. EPA DBE        | 2C. |     | 3B. RECIPIENT       | 3C. PHONE:   |
| COORDINATOR        | PHO |     | REPORTING CONTACT:  |              |
|                    | NE: |     |                     | Fax:         |
| Name:              |     |     | Name:               |              |
|                    | F   |     |                     |              |
| E-mail:            | ax: |     | E-mail:             |              |
+--------------------+-----+-----+---------------------+--------------+
| 4A. FINANCIAL      |     |     | 4B. FEDERAL         |              |
| ASSISTANCE         |     |     | FINANCIAL           |              |
| AGREEMENT ID       |     |     | ASSISTANCE PROGRAM  |              |
| NUMBER             |     |     | TITLE or CFDA       |              |
|                    |     |     |                     |              |
| (SRF State         |     |     | NUMBER:             |              |
| Recipients, refer  |     |     |                     |              |
| to Instructions    |     |     |                     |              |
| for Completion of  |     |     |                     |              |
| blocks             |     |     |                     |              |
|                    |     |     |                     |              |
| 4A, 5A and 5C.)    |     |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 5A. TOTAL          |     | 5B. |                     |              |
| ASSISTANCE         |     | If  |                     |              |
| AGREEMENT AMOUNT   |     | NO  |                     |              |
|                    |     | pr  |                     |              |
| (SRF State         |     | ocu |                     |              |
| Recipients, refer  |     | rem |                     |              |
| to Instructions    |     | ent |                     |              |
| for Completion of  |     | and |                     |              |
| blocks 4A, 5A and  |     | NO  |                     |              |
| 5C.)               |     | acc |                     |              |
|                    |     | omp |                     |              |
| EPA Share:         |     | lis |                     |              |
| \$\_\_\_\_\_       |     | hme |                     |              |
| \_\_\_\_\_\_\_\_\_ |     | nts |                     |              |
| \_\_\_\_\_\_\_\_\_ |     | w   |                     |              |
|                    |     | ere |                     |              |
| Recipient Share:   |     | m   |                     |              |
| \$\_\_\_           |     | ade |                     |              |
| \_\_\_\_\_\_\_\_\_ |     | t   |                     |              |
| \_\_\_\_\_\_\_\_\_ |     | his |                     |              |
|                    |     | rep |                     |              |
|                    |     | ort |                     |              |
|                    |     | ing |                     |              |
|                    |     | p   |                     |              |
|                    |     | eri |                     |              |
|                    |     | od, |                     |              |
|                    |     | ch  |                     |              |
|                    |     | eck |                     |              |
|                    |     | and |                     |              |
|                    |     | s   |                     |              |
|                    |     | kip |                     |              |
|                    |     | to  |                     |              |
|                    |     | Bl  |                     |              |
|                    |     | ock |                     |              |
|                    |     | No. |                     |              |
|                    |     | 7.  |                     |              |
|                    |     | ([P |                     |              |
|                    |     | roc |                     |              |
|                    |     | ure |                     |              |
|                    |     | men |                     |              |
|                    |     | ts] |                     |              |
|                    |     | {.u |                     |              |
|                    |     | nde |                     |              |
|                    |     | rli |                     |              |
|                    |     | ne} |                     |              |
|                    |     | are |                     |              |
|                    |     | all |                     |              |
|                    |     | exp |                     |              |
|                    |     | end |                     |              |
|                    |     | itu |                     |              |
|                    |     | res |                     |              |
|                    |     | t   |                     |              |
|                    |     | hro |                     |              |
|                    |     | ugh |                     |              |
|                    |     | con |                     |              |
|                    |     | tra |                     |              |
|                    |     | ct, |                     |              |
|                    |     | ord |                     |              |
|                    |     | er, |                     |              |
|                    |     | pur |                     |              |
|                    |     | cha |                     |              |
|                    |     | se, |                     |              |
|                    |     | le  |                     |              |
|                    |     | ase |                     |              |
|                    |     | or  |                     |              |
|                    |     | bar |                     |              |
|                    |     | ter |                     |              |
|                    |     | of  |                     |              |
|                    |     | sup |                     |              |
|                    |     | pli |                     |              |
|                    |     | es, |                     |              |
|                    |     | e   |                     |              |
|                    |     | qui |                     |              |
|                    |     | pme |                     |              |
|                    |     | nt, |                     |              |
|                    |     | c   |                     |              |
|                    |     | ons |                     |              |
|                    |     | tru |                     |              |
|                    |     | cti |                     |              |
|                    |     | on, |                     |              |
|                    |     | or  |                     |              |
|                    |     | se  |                     |              |
|                    |     | rvi |                     |              |
|                    |     | ces |                     |              |
|                    |     | nee |                     |              |
|                    |     | ded |                     |              |
|                    |     | to  |                     |              |
|                    |     | co  |                     |              |
|                    |     | mpl |                     |              |
|                    |     | ete |                     |              |
|                    |     | F   |                     |              |
|                    |     | ede |                     |              |
|                    |     | ral |                     |              |
|                    |     | a   |                     |              |
|                    |     | ssi |                     |              |
|                    |     | sta |                     |              |
|                    |     | nce |                     |              |
|                    |     | pro |                     |              |
|                    |     | gra |                     |              |
|                    |     | ms. |                     |              |
|                    |     | [Ac |                     |              |
|                    |     | com |                     |              |
|                    |     | pli |                     |              |
|                    |     | shm |                     |              |
|                    |     | ent |                     |              |
|                    |     | s]{ |                     |              |
|                    |     | .un |                     |              |
|                    |     | der |                     |              |
|                    |     | lin |                     |              |
|                    |     | e}, |                     |              |
|                    |     | in  |                     |              |
|                    |     | t   |                     |              |
|                    |     | his |                     |              |
|                    |     | co  |                     |              |
|                    |     | nte |                     |              |
|                    |     | xt, |                     |              |
|                    |     | are |                     |              |
|                    |     | pro |                     |              |
|                    |     | cur |                     |              |
|                    |     | eme |                     |              |
|                    |     | nts |                     |              |
|                    |     | m   |                     |              |
|                    |     | ade |                     |              |
|                    |     | w   |                     |              |
|                    |     | ith |                     |              |
|                    |     | M   |                     |              |
|                    |     | BEs |                     |              |
|                    |     | and |                     |              |
|                    |     | /or |                     |              |
|                    |     | WB  |                     |              |
|                    |     | Es. |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 5C. **Total        |     |     |                     |              |
| Procurement and    |     |     |                     |              |
| MBE/WBE            |     |     |                     |              |
| Accomplishments    |     |     |                     |              |
| This Reporting     |     |     |                     |              |
| Period**           |     |     |                     |              |
|                    |     |     |                     |              |
| (Only include      |     |     |                     |              |
| amount not         |     |     |                     |              |
| reported in any    |     |     |                     |              |
| prior reporting    |     |     |                     |              |
| period)            |     |     |                     |              |
|                    |     |     |                     |              |
| Were sub-awards    |     |     |                     |              |
| issued under this  |     |     |                     |              |
| assistance         |     |     |                     |              |
| agreement?         |     |     |                     |              |
| Yes\_\_\_          |     |     |                     |              |
| No\_\_\_\_ Were    |     |     |                     |              |
| contracts issued   |     |     |                     |              |
| under this         |     |     |                     |              |
| assistance         |     |     |                     |              |
| agreement ?        |     |     |                     |              |
| Yes\_\_\_\_        |     |     |                     |              |
| No\_\_\_\_         |     |     |                     |              |
|                    |     |     |                     |              |
| Total Procurement  |     |     |                     |              |
| Amount             |     |     |                     |              |
| \$\_\_\_\_\_\_     |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| (Include total     |     |     |                     |              |
| dollar values      |     |     |                     |              |
| awarded by         |     |     |                     |              |
| recipient,         |     |     |                     |              |
| sub-recipients and |     |     |                     |              |
| SRF loan           |     |     |                     |              |
| recipients.)       |     |     |                     |              |
|                    |     |     |                     |              |
| Actual MBE/WBE     |     |     |                     |              |
| Procurement        |     |     |                     |              |
| Accomplished:      |     |     |                     |              |
|                    |     |     |                     |              |
| (Include total     |     |     |                     |              |
| dollar values      |     |     |                     |              |
| awarded by         |     |     |                     |              |
| recipient,         |     |     |                     |              |
| sub-recipients,    |     |     |                     |              |
| SRF loan           |     |     |                     |              |
| recipients and     |     |     |                     |              |
| Prime              |     |     |                     |              |
| Contractors.)      |     |     |                     |              |
|                    |     |     |                     |              |
| **[Constru         |     |     |                     |              |
| ction]{.underline} |     |     |                     |              |
| [Equi              |     |     |                     |              |
| pment]{.underline} |     |     |                     |              |
| [Ser               |     |     |                     |              |
| vices]{.underline} |     |     |                     |              |
| [Sup               |     |     |                     |              |
| plies]{.underline} |     |     |                     |              |
| [To                |     |     |                     |              |
| tal]{.underline}** |     |     |                     |              |
|                    |     |     |                     |              |
| **\$MBE:**         |     |     |                     |              |
| \_\_\_             |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_           |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_           |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_           |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_\_\_\_     |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
|                    |     |     |                     |              |
| **\$WBE:**         |     |     |                     |              |
| \_\_\_             |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_\_         |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_\_         |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_           |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
| \_\_\_\_\_\_\_     |     |     |                     |              |
| \_\_\_\_\_\_\_\_\_ |     |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 6\. COMMENTS: (If  |     |     |                     |              |
| no MBE/WBE         |     |     |                     |              |
| procurements were  |     |     |                     |              |
| accomplished       |     |     |                     |              |
| during the         |     |     |                     |              |
| reporting period,  |     |     |                     |              |
| please explain     |     |     |                     |              |
| what steps you are |     |     |                     |              |
| taking to achieve  |     |     |                     |              |
| the MBE/WBE        |     |     |                     |              |
| Program            |     |     |                     |              |
| requirements       |     |     |                     |              |
| specified in the   |     |     |                     |              |
| terms and          |     |     |                     |              |
| conditions of the  |     |     |                     |              |
| Assistance         |     |     |                     |              |
| Agreement.)        |     |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 7\. NAME OF        | TI  |     |                     |              |
| RECIPIENT'S        | TLE |     |                     |              |
| AUTHORIZED         |     |     |                     |              |
| REPRESENTATIVE     |     |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+
| 8\. SIGNATURE OF   | D   |     |                     |              |
| RECIPIENT'S        | ATE |     |                     |              |
| AUTHORIZED         |     |     |                     |              |
| REPRESENTATIVE     |     |     |                     |              |
+--------------------+-----+-----+---------------------+--------------+

EPA FORM 5700-52A available electronically at
<http://www.epa.gov/osbp/pdfs/5700_52a.pdf>

**MBE/WBE PROCUREMENTS MADE DURING REPORTING PERIOD**

**EPA Financial Assistance Agreement Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

+---+----+---+---+----+-------+------+-------+---------------------+
| 1 |    |   | 2 |    | 3\.   | 4\.  | 5\.   | 6\.                 |
| \ |    |   | \ |    | \$    | Date | Type  | Name/Address/Phone  |
| . |    |   | . |    | Value | of   | of    | Number of MBE/WBE   |
| P |    |   | B |    | of    | A    | Pr    | Contractor or       |
| r |    |   | u |    |       | ward | oduct | Vendor              |
| o |    |   | s |    | P     |      | or    |                     |
| c |    |   | i |    | rocur | MM/D |       |                     |
| u |    |   | n |    | ement | D/YY | Serv  |                     |
| r |    |   | e |    |       |      | icesA |                     |
| e |    |   | s |    |       |      |       |                     |
| m |    |   | s |    |       |      | (     |                     |
| e |    |   | E |    |       |      | Enter |                     |
| n |    |   | n |    |       |      | Code) |                     |
| t |    |   | t |    |       |      |       |                     |
| M |    |   | e |    |       |      |       |                     |
| a |    |   | r |    |       |      |       |                     |
| d |    |   | p |    |       |      |       |                     |
| e |    |   | r |    |       |      |       |                     |
| B |    |   | i |    |       |      |       |                     |
| y |    |   | s |    |       |      |       |                     |
|   |    |   | e |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
| R | S  | P | M | W  |       |      |       |                     |
| e | ub | r | i | om |       |      |       |                     |
| c | -R | i | n | en |       |      |       |                     |
| i | ec | m | o |    |       |      |       |                     |
| p | ip | e | r |    |       |      |       |                     |
| i | ie |   | i |    |       |      |       |                     |
| e | nt |   | t |    |       |      |       |                     |
| n | an |   | y |    |       |      |       |                     |
| t | d/ |   |   |    |       |      |       |                     |
|   | or |   |   |    |       |      |       |                     |
|   | S  |   |   |    |       |      |       |                     |
|   | RF |   |   |    |       |      |       |                     |
|   | Lo |   |   |    |       |      |       |                     |
|   | an |   |   |    |       |      |       |                     |
|   | R  |   |   |    |       |      |       |                     |
|   | ec |   |   |    |       |      |       |                     |
|   | ip |   |   |    |       |      |       |                     |
|   | ie |   |   |    |       |      |       |                     |
|   | nt |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+
|   |    |   |   |    |       |      |       |                     |
+---+----+---+---+----+-------+------+-------+---------------------+

Type of product or service codes:

1 = Construction 2 = Supplies 3 = Services 4 = Equipment

Note: Refer to Terms and conditions of your Assistance Agreement to
determine the frequency of reporting. Recipients are required to submit
MBE/WBE reports to EPA beginning with the Federal fiscal year quarter
the recipients receive the award, continuing until the project is
completed.

EPA FORM 5700-52A - (Approval Expires 01/31/11)

**Instructions:**

**A. General Instructions:**

MBE/WBE utilization is based on Executive Orders 11625, 12138, 12432,
P.L. 102-389 and EPA Regulations Part 30 and 31. EPA Form 5700-52A must
be completed by recipients of Federal grants, cooperative agreements, or
other Federal financial assistance which involve procurement of
supplies, equipment, construction or services to accomplish Federal
assistance programs.

Recipients are required to report 30 days after the end of each federal
fiscal quarter or annually, per the terms and conditions of the
financial assistance agreement. Submission dates are January 30, April
30, July 30, and October 30. The submission date for annual reports is
October 30. MBE/WBE program requirements, including reporting, are
material terms and conditions of the financial assistance agreement.

**B. Definitions:**

*Procurement* is the acquisition through contract, order, purchase,
lease or barter of supplies, equipment, construction or services needed
to accomplish Federal assistance programs.

*A contract* is a written agreement between an EPA recipient and another
party (also considered "prime contracts") and any lower tier agreement
(also considered "subcontracts") for equipment, services, supplies, or
construction necessary to complete the project. This definition excludes
written agreements with another public agency. This definition includes
personal and professional services, agreements with consultants, and
purchase orders.

*A minority business enterprise* (MBE) is a business concern that is (1)
at least 51 percent owned by one or more minority individuals, or, in
the case of a publicly owned business, at least 51 percent of the stock
is owned by one or more minority individuals; and (2) whose daily
business operations are managed and directed by one or more of the
minority owners.

U.S. citizenship is required. Recipients shall presume that minority
individuals include Black Americans, Hispanic Americans, Native
Americans, Asian Pacific Americans, or other groups whose members are
found to be disadvantaged by the Small Business Act or by the Secretary
of Commerce under section 5 of Executive order 11625. The reporting
contact at EPA can provide additional information.

*A woman business enterprise* (WBE) is a business concern that is, (1)
at least 51 percent owned by one or more women, or, in the case of a
publicly owned business, at least 51 percent of the stock is owned by
one or more women and (2) whose daily business operations are managed
and directed by one or more of the women owners.

Business firms which are 51 percent owned by minorities or women, but
are in fact managed and operated by non-minority individuals do not
qualify for meeting MBE/WBE procurement goals. U.S. Citizenship is
required.

The following affirmative steps for utilizing MBEs and WBEs must be
documented. Such documentation is subject to EPA review upon request:

**1 Include of MBEs/WBEs on solicitation lists.**

2\. Assure that MBEs/WBEs are solicited once they are identified.

3\. Divide total requirements into smaller tasks to permit maximum
MBE/WBE participation, where feasible.

4\. Establish delivery schedules which will encourage MBE/WBE
participation, where feasible.

5\. Encourage use of the services of the U.S. Department of Commerce\'s
Minority Business Development Agency (MBDA) and the U.S. Small Business
Administration to identify MBEs/WBEs.

6\. Require that each party to a subgrant, subagreement, or contract
award take the affirmative steps outlined here.

**C. Instructions for Part I:**

1a. Specify Federal fiscal year this report covers. The Federal fiscal
year runs from October 1st through September 30th (**e.g. November 29,
2005 falls within Federal fiscal year 2006**)

1b. Check applicable reporting box, quarterly or annually. Also indicate
if this is the last report for the project.

1c. Indicate if this is a revision to a previous year or quarter, and
provide a brief description of the revision you are making.

2a-c. Please refer to your financial assistance agreement for the
mailing address of the EPA financial assistance office for your
agreement.

> The "EPA DBE Reporting Contact" is the DBE Coordinator for the EPA
> Region from which your financial assistance agreement was originated.
> For a list of DBE Coordinators please refer to the EPA OSDBU website
> at www.epa.gov/osdbu. Click on "Regional Contacts" for the name of
> your coordinator.

3a-c. Identify the agency, state authority, university or other
organization which is the recipient of the Federal financial assistance
and the person to contact concerning this report.

4a. Provide the Assistance Agreement or Interagency Agreement number
assigned by EPA. A separate report must be submitted for each Assistance
Agreement or Interagency Agreement.

> **\*For SRF recipients**: In box 4a list numbers for ALL open
> Assistance Agreements. SRF recipients will report activity for all
> Agreements on one form.

4b. Refer back to Assistance Agreement document for this information.

5a. Provide the total amount of the Assistance Agreement which includes
Federal funds plus recipient matching funds and funds from other
sources.

> **\*For SRF recipients only**: SRF recipients will not enter an amount
> in 5a. Please leave 5a blank.

5b. Self-explanatory.

5c. State whether or not sub-awards and/or subcontracts have been issued
under the assistance agreement by indicating "yes" or "no".

> Provide the total dollar amount of all contracts/procurements awarded
> this reporting period by the recipient and all sub-recipients, and SRF
> loan recipients. For example: Actual dollars for procurement from the
> procuring office; actual contracts let from the contracts office;
> actual goods, services, supplies, etc., from other sources including
> the central purchasing/ procurement centers).
>
> Where requested, also provide the total dollar amount of all MBE/WBE
> procurement awarded during this reporting period by the recipient,
> sub-recipients, SRF loan recipients, and prime contractors in the
> categories of construction, equipment, services and supplies. These
> amounts include the Federal, State and local shares in the procurement
> awards.
>
> **\*For SRF recipients only**: In 5c please enter the total
> procurement amount for the quarter under all of your SRF Assistance
> Agreements. The figure reported in this section is **not** directly
> tied to an individual Assistance Agreement identification number.
> **(SRF state recipients report state procurements in this section)**

6\. If there were no MBE/WBE accomplishments this reporting period,
please briefly explain what steps you are taking in furtherance of the
MBE/WBE requirements specified in the terms and conditions of the
Assistance Agreement.

7\. Name and title of official administrator or designated reporting
official.

8\. Signature and month, day year report submitted.

**D. Instructions for Part II:**

For each MBE/WBE procurement made under this assistance agreement during
the reporting period, provide the following information:

1\. Check whether this procurement was made by the recipient,
sub-recipient/SRF loan recipient, or the prime contractor.

2\. Check either the MBE or WBE column. If a firm is both an MBE and
WBE, the recipient may choose to count the entire procurement towards
EITHER its MBE or WBE accomplishments. The recipient may also divide the
total amount of the procurement (using any ratio it so chooses) and
count those divided amounts toward its MBE and WBE accomplishments. If
the recipient chooses to divide the procurement amount and count
portions toward its MBE and WBE accomplishments, please state the
appropriate amounts under the MBE and WBE columns on the form. **The
combined MBE and WBE amounts for that MBE/WBE contractor must not exceed
the "Value of the Procurement" reported in column #3**

3\. Dollar value of procurement.

4\. Date of award, shown as month, day, year. Date of award is defined
as the date the contract or procurement was awarded, **not** the date
the contractor received payment under the awarded contract or
procurement, unless payment occurred on the date of award. **(Where
direct purchasing is the procurement method, the date of award is the
date the purchase was made)**

5\. Using codes at the bottom of the form, identify type of product or
service acquired through this procurement (eg., enter 1 if construction,
2 if supplies, etc).

6\. Name, address, and telephone number of MBE/WBE firm.

\*\*This data is requested to comply with provisions mandated by:
statute or regulations (40 CFR Part 30 and 31); OMB Circulars; or added
by EPA to ensure sound and effective assistance management. Accurate,
complete data are required to obtain funding, while no pledge of
confidentiality is provided.

The public reporting and recording burden for this collection of
information is estimated to average l hour per response annually. Burden
means the total time, effort, or financial resources expended by persons
to generate, maintain, retain, or disclosure or provide information to
or for a Federal agency. This includes the time needed to review
instructions; develop, acquire, install, and utilize technology and
systems for the purposes of collecting, validating, and verifying
information, processing and maintaining information, and disclosing and
providing information; adjust the existing ways to comply with any
previously applicable instructions and requirements; train personnel to
be able to respond to a collection of information; search data sources;
complete and review the collection of information; and transmit or
otherwise disclose the information. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number.

Send comments on the Agency\'s need for this information, the accuracy
of the provided burden estimates, and any suggested methods for
minimizing respondent burden, including through the use of automated
collection techniques to the Director, OPPE Regulatory Information
Division, U.S. Environmental Protection Agency (2136), 1200 Pennsylvania
Avenue, NW, Washington, D.C. 20460. Include the OMB Control number in
any correspondence. Do not send the completed form to this address.