Multitech MT5634IND Especificaciones descargar pdf (Pagina 21)

WISCONSIN DEPARTMENT OF BID #268246 TRAFFIC DATA RECORDERS

TRANSPORTATION PAGE 21 OF 23

ATTACHMENT D

MINORITY BUSINESS PARTICIPATION REPORT

Wisconsin Department of Transportation

DT1230 8/2006 s.16.75(3m) Wis. Stats.

Return via FAX to:

Return via e-mail to:

608-267-3609, ATTN: Purchasing Minority Business Coordinator

Report Date

Contract / Purchase Order #

Time Period Covered by Report

Monthly:

through

Quarterly: #1

Project Name / Contract Title

Prime Vendor / Contractor Name

Federal Employer Identification Number – FEIN

Minority Vendor

Contractor Name, Address and Telephone Number

Product / Service

Purchased

Subcontract

$ Amount

Second Tier

$ Amount

If no business was awarded to Minority Business Enterprises (MBE) for this period, please describe the efforts made to

encourage minority business participation. If you have questions, please call the WisDOT Minority Business Program

Specialist, 608-267-2886.

___________________________________________________________________________________________________________________________________

I certify that the information contained on this report is true and correct.

I also certify that I am an authorized representative of the above-identified Prime Vendor / Contractor.

(Prime Vendor/Contractor Authorized Representative Name)

(Title)

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Multitech MT5634IND Especificaciones Pagina 21