EPA FORM 6100-2 (DBE Subcontractor Participation Form) Disadvantaged Business Enterprise (DBE) Program DBE Subcontractor Participation Form An EPA Financial Assistance Agreement Recipient must require its prime contractors to provide this form to its DBE subcontractors. This form gives a DBE 1 subcontractor 2 the opportunity to describe work received and/or report any concerns regarding the EPA-funded project (e.g., in areas such as termination by prime contractor, late payments, etc. ). The DBE subcontractor can, as an option, complete and submit this form to the EPA DBE Coordinator at any time during the project period of performance. Subcontractor Name Project Name Bid/ Proposa l No. Assistance Agreement ID No. (if known) Point of Contact Address Telephone No. Email Address Prime Contractor Name Issuing/Funding Entity: Contract Item Number Description of Work Received from the Prime Contractor Involving Construction, Services , Equipment or Supplies Amount Received by Prime Contractor

1 A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certifications as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2 Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. OMB Control No: 2090-0030 Approval Expires: XX/XX/XXEPA FORM 6100-2 (DBE Subcontractor Participation Form) OMB Control No: Approved: Approval Expires: Disadvantaged Business Enterprise (DBE) Program

DBE Subcontractor Participation Form Please use the space below to report any concerns regarding the above EPA-funded project:

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The public reporting and recordkeeping burden for this collection of information is estimated to average 1 hour per response. 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, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

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