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04/11/2002 23:24 9529309043 LASZLO FULOP PAGE 04I21 SMALL BUStNESS ENTERPRISE PROGRAM INSTRUC710NS FOR FIUNG THE S�E PROGRESS PAYMEN7 REPORT (FoRM SBEBj The SB�progress payment report, Form SB�S, includes payments made to Small Business �nterprises (SBEs)that provide products/services for Hennepin County projects. The reports are to be completed by-the Prime Contractor and signed by an authorized representative of the company. The Prime Contr�ctor must submit the rer�ort bv the 10�'cafendar dav follawint�ths auplicable l�uarterfv or Monthlv�,reportino oe�iod to Hennepin County Purchasing 8 Targeted Contract Services Division,A-2205 Government Center,300 South Sixth Street,Mtnneapolis, MN 55487-0228,Attention: Small Business Enterprise Program. If you have questions or need assistance, please call Joyce Brown at(612)348-5960 or Kathy Capra at(612)348-7077. (9)Project No. Enter the County project number as stated in your County contract documents. (if you are a subC4ntractor on a County contract, contact your prime - . • contractor to obtaln this information.) - �-� --- (2}Contract No. Enter the County contract number as stated in your County�contract documents. (If you are a subcontractor on a County contract,cont�ct your prime contractor to obtain this informatian.) (3) Company fvama Enter the name af your company in this section_ (4)Telephone No.and Fax No. Enter your companys telephone and Fax number in this section. (5)Address Enter your company's adtlress in this section. (6)Contract Amount Enter the amount of yaur County contract. (7)Payments Received#o Date Indlcate the total amount of payments received an the contract to date. (8)Finai Report Piace a�l mark in the appropriate bax to indicate whether or not this is the final report for the contract. (9) Report Period Enter the dates covered by the report(e_g.,the month of 2/1/02--2/28/02 or the quarter of'f 0/1/02— 12/31/02). (10)Name of Small Business (SBE) lndiCate the name(s)of SBE(s)currently working as a subconiractor for your company on this contract. (11)Small Business Contract Amount • Enter the amount of the SB.E contract. (12)V1/ork/Service Performed Enter the type of work/service performed by the S�E. (13)Amount Paid This Period Enter the amount paid to the SSE for thls reparting period. (14)Total Amount Paid to Date Enter the total amount paid to the SBE to date. ('15}Balance Due Enter the balance due on the 58E contract. (16)Authorized Representative The company's authorized representative must print, si n and date this report. THtS R�PORT MUST B�SIGNED BY A COMPANY OFFICIAL OR AUTHORIZED R�PRESENTATIVE FORM SBEB � . L. Rev.3/4/02 p. 1 ot 2