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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 MBEsNVBEs . 6 . Require that each party to a subgrant, subagreement, or contract award take the affirmative steps outlined here . A separate report must be submitted for each funding source under this Agreement. For each MBENVBE procurement made under this Agreement during the reporting period , provide the following information : 1 . Enter the Grantee agency name . 2 . The EPA Financial Assistance Agreement Number is located in this Agreement. 3 . The Reporting ( Performance) Period should be the same Performance Period shown on the Payment Request Summary Form that is being submitted with this Report. 4 . 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 Grantee 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 , lease state theappropriate amounts under the MBE and WBE columns on the P P P form . The combined MBE and WBE amounts for that MBE/WBE contractor must not exceed the "Value of the Procurement' reported in column #3 5 . Dollar value of procurement. 6 . Date of award , shown as month , day, and year. Date of award is defined as the last date of execution , not the date the contractor received payment under the awarded contract or procurement, unless payment occurred on the date of execution . (Where direct purchasing is the procurement method , the date of execution is the date the purchase was made) 7 . Using codes at the bottom of the form , identify type of product or service acquired through this procurement (e. g . , enter 1 if construction , 2 if supplies, etc) . 8 . 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 . For assistance with the completion of this form , please contact Jennifer. Peddicord , Finance and Accounting Director, at (850) 245-2456 . DEP Agreement No. G0353 , Attachment C, Page 3 of 3