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ATTACHMENT # J SUBCONTRACTOR MINORITY STATUS REPORT Date: Contractor Company Name, Street Address, City & Zip Code: Indian River County BOCC 1801 27TH Street, Bldg. A Vero Beach, FL 32960 FEIN: 69-6000674 FWC Solicitation/Contract Number: # 25203 FWC Project Title: 25203 Indian River County DV Project Contract Amount: $6,900.00 Invoice Number: 26203 The Contractor shall indicate "N/A" if the project does not utilize subcontractors. Primary Primary Primary Primary Contractor Subcontractor Name Subcontractor 'CBE Contractor Contractor Subcontractor Contractor Name CBE Code Invoice # Payment FEIN # Code Description of Service Payment Indian River Amount Amount County BOCC $6,900.00 $ $ $ Total of Subcontractor Payments) $ 'OSD Certification Status: Check certification status using the OSD Certified Businesses Directory at: https://os(i.diiis.mvfloi•id�i coin/directories orMyFloridaMarketPlace (MFMP) Vendor Information Portal at: httus://vendor.mvfloa-idamai•ketplace coin 'CBE Codes: A - Non -Minority I H - African-American, Certified I I - Hispanic, Certified I J - Asian -American business, Certified I K - Native American, Certified I M - Women -Owned, Certified I N - African-American, Non -Certified 1 O - Hispanic, Non -Certified I P - Asian -American, Non -Certified I Q - Native American, Non -Certified I R - Woman -Owned, Non -Certified I W - Service- Disabled Veteran Business Enterprise, Certified The State of Florida's Office of Supplier Diversity (OSD) certifies woman-, veteran-, and minority-owned businesses for free. If a subcontractor is a woman-, veteran-, or minority-owned business that is not certified by the State of Florida, refer them to OSD to learn more about the benefits of this free certification: www.dms.myflorida.com/osd or 850-487-0915. INCLUDE THIS FORM WITH EACH INVOICE FOR PAYMENT $Nod D o th Woo Oz 0A Al -Op < < Z ~ T ? rn x OZ �a 5, J �T {J n.1