ADMINISTRATIVE PROCEDURES AGING SCHOOLS PROGRAM PUBLIC SCHOOL CONSTRUCTION PROGRAM

Transcription

1 ADMINISTRATIVE PROCEDURES AGING SCHOOLS PROGRAM PUBLIC SCHOOL CONSTRUCTION PROGRAM May 2014 Public School Construction Program 200 W. Baltimore Street Baltimore, MD (410) (410) FAX

2 ADMINISTRATIVE PROCEDURES AGING SCHOOLS PROGRAM I. Purpose The Aging Schools Program (ASP) provides State funds to all school systems in the State of Maryland to address the needs of their aging school buildings. These funds may be utilized for capital improvement projects in existing public school buildings and sites serving students. These funds may also be used to fund controlled access systems that allow school staff to lock facility doors and control visitor access with cameras, intercom systems and remote buzzers. II. Background Maryland s Aging Schools Program was established by legislation in Subsequent legislation extended and modified it. 1 Funds are distributed in accordance with the Education Article. 2 Beginning with fiscal year 2010, funding for the Program was provided from proceeds of State general obligation bonds. Eligible projects were thereafter restricted to those having at least a 15- year anticipated lifespan. The ASP is administered by the Interagency Committee on School Construction (IAC) in accordance with COMAR Regulations for the Administration of the Public School Construction Program,.19 Aging Schools Program. The IAC approves expenditures and develops administrative procedures for the Program. As in FY 2014, the IAC encourages LEAs to examine every submitted ASP project to determine if it is reasonably feasible to carry out security enhancements. III. Allocations Funding allocations are based on a Local Education Authority s (LEA) proportion of older facility space compared to statewide totals. Funds, however, are not restricted to projects in areas of school buildings that have not been renovated since The FY 2015 Allocations for each LEA are shown in Attachment I. ASP general obligation bond funds are available for State-approved projects beginning each July 1. Funds allocated to a school system in a fiscal year must be placed under contract before the end of the fiscal year of the allocation. Contracted funds must be expended and reimbursed within six months following the end of the fiscal year in which the funds were allocated. Any uncontracted funds as of the following June 30th will be reserved for the LEA and re-allocated with the next fiscal year allocations. State funds provided through the ASP do not require matching local funds. State-Local cost share percentages used for other State-funded school construction projects do not apply to ASP funding. 1 History of ASP legislation, Senate/House bills, and chapter and year of Maryland Law: SB795, Chapter 105, 1997 Established SB856, Chapter 288, 2002 Extended SB498, Chapter 388, 2003 Extended HB1230/SB787, Chapter 307, 2004 Allocation formula revised, program made perpetual HB300/SB191, Chapter 432, 2004 Additional funding to mitigate allocation revision SB432/HB705, Chapter 252, 2006 Adjusted per Consumer Price Index HB102/SB167, Chapter 485, 2009 Allocations reduced to $6.1 million HB71/SB86, Chapter 396, 2011 Allocations increased to $8.6 million SB151/HB86, Chapter 444, 2012 Allocations increased to $ million HB101/SB126, Chapter 424, 2013 Baltimore County allocation increased by $2 million SB171/HB161, Chapter TBD, 2014 Allocations reduced to $6.1 million 2 Section 5-206(f)(2)(ii) Distribution of Grants - Aging Schools Program Page 1

3 IV. Application and Approval Procedures A. Eligible Projects/Expenditures In general, eligible projects and expenditures are for capital improvements to public school buildings and sites that, when completed, would protect the school building from deterioration, improve the safety of students and staff, and enhance the delivery of educational programs. Specifically, the following requirements should be fulfilled: The project must be of a distinctive type in a single building and within the list of eligible expenditures shown in Attachment II. 1. The amount of ASP funding requested must be at least $10,000 and no more than the total State allocation for the LEA, but there are no restrictions on the LEA providing additional funds for the project. 2. The building or building system improved by the project must have a minimum calculated age of 16 years at the time the funding request is submitted. Age will be calculated from the following: a) Original occupancy date if never renovated, or ; b) Occupancy date following a complete renovation, or ; c) Average of original occupancy date and post-partial renovation occupancy date. 3. The school s utilization rate should be at least 60%, however the LEA may submit documentation for approval justifying the project if the rate is less. 4. Projects placed under contract before approval by the IAC are not eligible. B. Ineligible Projects/Expenditures Ineligible projects and expenditures are the same as those specified in COMAR , Regulations on the Administration of the Public School Construction Program, Ineligible Expenditures. Attachment III provides a listing of ineligible items. Additionally, ASP funds may not be used: To increase the State or local share of a project To supplement an approved State allocation for a project For improvements to property owned by a board of education that is not used by public school students For a contractual period exceeding one year For improvements to or the movement of relocatable classroom buildings For the establishment of a contingency account for change orders for any public school construction project. Page 2

4 C. Application Process The LEA must upload their application to the SharePoint portal for review and approval by the IAC using the ASP application in electronic format (see Attachment IV). Refer to the Instructions for Submission of Aging Schools Program (ASP) Application to the PSCP SharePoint Portal document for specific directions. The application should list the proposed projects in priority order and include one or two paragraphs describing in detail the existing conditions and the proposed scope of work including the determination of the applicability of the Emergency Shelter Compliance Process. The submission should also include: 1. The actual age of the building or building system improved. 2. The number of units or square footage involved, if appropriate. 3. A cost estimate for the project. 4. The anticipated dates of commencement and completion of the work. 5. The method by which the work will be accomplished, e.g. competitive bids, existing openended contracts, or purchase orders. 6. The category identified for design or specification services that will be utilized for the project, e.g. architect, engineer, consultant, staff. For those projects that would qualify as systemic renovations under the Capital Improvement Program, the same information required for CIP submissions is required for the ASP. The ASP list of projects may be submitted following a date specified by the IAC annually, and must be submitted at least 60 days before the end of the fiscal year for which funding is available. After projects are approved and assigned a PSC/ASP number, the LEA may determine that another project is of a higher priority. The LEA may then request a substitution for the previously approved ASP project. The request will be subject to review and approval as for all ASP projects. The cumulative cost estimate for the proposed projects may exceed the LEA s allocation by no more than ten (10) percent. The proposed work estimate may be adjusted upon request from the LEA at the time of contract award approval or approval of the purchase order. Funding is limited to the LEA s total annual allocation. D. Project Approval Process Requests from the school systems will be reviewed and processed as they are received. The following will be considered: Type of work Age of the building or system Current CIP for other work planned at the facility The utilization rate of the school It is anticipated that projects will be approved within ten (10) working days of a complete submission. A PSC/ASP project number will then be assigned. A project can then proceed through the design and/or procurement process. Attachment II lists the levels of review required for eligible expenditures prior to advertising and bidding. The State may alter these requirements at its discretion. Failure to comply with these review requirements will result in the project being deemed ineligible for State funding. The submission requirements for projects that repair or replace components of a building system could be reduced during the initial review process. The LEA will be required to provide an Environmental Assessment Form (IAC/PSCP Form 104.2) to the State Clearinghouse if the project will change the footprint of the existing facility. The Maryland Emergency Management Agency (MEMA) is to be consulted for each project that involves a replacement or upgrade of the electrical system, to determine which areas for the school may be used for public shelter during a national, state, or local emergency event. In addition, the public school construction project is to include the electrical capability to Page 3

5 fully power those areas designated by MEMA. COMAR Refer to Administrative Procedures Guide Section 106 Emergency Shelter Compliance Process. The Maryland Historical Trust (MHT) must be consulted on all projects for State funding, requiring standard review as set forth in the Programmatic Agreement. The LEA should review the MHT Schools by Category list for projects receiving State funding to determine if consultation with MHT is applicable to the requested project. The project review submission form is available at Contact Jonathan Sager, Maryland Historical Trust at (410) or if you have any questions. V. Procurement/Contract Awards Procurements shall be in compliance with COMAR Construction Procurement Methods as well as with State public school procurement law Section Bids of the Education Article. State ASP funds may only be expended for projects which are placed under contract or procured after a PSC/ASP number is assigned and the project has proceeded through the required review process for the specific project type. Failure to comply with this requirement will result in the withholding of funds for that project. The school system may then substitute another project for review and approval. Change orders for all projects may be approved at the local school system level, however, any change order for $25,000 or more will require State review and approval prior to issuance. State Approval of Change Orders exceeding $25,000 does not necessarily ensure State funding for the change order, unless funding is available. The following will apply: (a) Projects which cost less than $25,000 do not require IAC approval of the procurement and, generally, sealed bids are not required unless a local board of education policy or procedure has a dollar value that requires sealed bids. (b) Projects which cost at least $25,000 but less than $100,000 are required to be bid, consistent with Section Bids of the Education Article. IAC approval of contracts with a total cost of less than $100,000 is not required prior to entering into the contract but is subject to State review at the time reimbursement is requested. A copy of the bid tabulation must be submitted with IAC/PSCP Form 4000 Project Reimbursement/Expenditure Report for the ASP project. (c) Projects which cost $100,000 or more are required to be bid, consistent with Section Bids of the Education Article. IAC approval of the contract award is required prior to the board of education entering into the contract. A copy of the bid tabulation with a copy of the low bidder's proposal must be submitted for State review and approval of the contract award. An existing State or local contract which was previously competitively bid can be utilized for any project in the funding levels described above. The previously approved contract number, the bid date, and the expiration date of the contract should be submitted. Projects over $500,000 in which the State participation is more than 25% of the total contract value, can utilize an existing State or local contract, so long as verification is provided that prevailing wages are paid, in accordance with State Finance and Procurement Article through The LEA must utilize its MBE procedures for all ASP project procurements. All requests for reimbursement must include a completed Project Reimbursement/Expenditures Report, Minority Business Enterprise Participation Form (See Attachment VI) Adherence to the MBE procedures is required for all ASP project procurements to ensure reimbursement at project completion. Projects with a construction value estimate in excess of $50,000 are required to submit a MBE Goal Setting Analysis to PSCP, as specified in Subsection Page 4

6 5.d of the amended Section 4.0 MBE Goals Setting Procedures. For projects with a construction value in excess of $200,000, the Form should also be sent to the Governor s Office of Minority Affairs (GOMA). Any questions regarding MBE submissions should be direct to: Azariah Moore MBE Manager Public School Construction Program 200 W. Baltimore Street Baltimore, MD Phone: Fax: amoore@msde.state.md.us A State school construction sign is required for ASP projects costing $100,000 or more. These signs are available from the Maryland Correctional Enterprises (MCE) Sign Plant, C/O Patuxent Institution, Attn: Charles Behnke, 7555 Waterloo Road, Jessup, MD 20794; their telephone number is (410) They may be ordered by faxing a purchase order to (410) The address for the Sign Shop is cwbehnke@dpscs.state.md.us. See Attachment VIII Construction Sign, for a mock-up of the sign. VI. Processing For Payment Payment for work completed under the ASP will be through reimbursement to the school system. The State will provide a single payment to the school system at the completion of the project. Upon completion of the project, the school system should submit IAC/PSCP form RE 4000 Project Reimbursement/Expenditure Report (see Attachment V) and IAC/PSCP form page 3 Certified Minority Business Enterprise Participation (see Attachment VI). Copies of cancelled checks and contractor's requisitions/invoices or paid purchase orders must accompany this form. If the contractor s requisitions/invoices do not provide a description of the type of work performed, a copy of the purchase order or contract shall be provided. No other financial reports or documentation need be submitted to process the reimbursement request. As with all State-funded school construction projects, supporting documentation must be retained until future audit. In lieu of submitting a copy of the cancelled check from the bank, the Contractor s Certification of Receipt of Payment (IAC/PSCP form 306.2a) will be accepted to initiate reimbursement. It must be signed by the contractor and notarized. This form (Attachment VII) must accompany IAC/PSCP form RE Cancelled checks (originals) must be maintained by the LEA for subsequent review by PSCP auditors. If the request for reimbursement differs from the amount specified in the initial submission, the school system must submit a brief explanation of the difference and specify the action requested by the school system. All requests for reimbursement shall be submitted 30 days prior to the end of the calendar year in which reimbursement is required. VII. Future Project Funding If a public school building is renovated through the Public School Construction Program within 15 years of the completion of an ASP project, the maximum State construction allocation for the renovation or limited renovation of the building shall be adjusted to account for the State's previous ASP allocation. Local funds expended for such improvements will not be deducted in future years from the maximum State construction allocation. Page 5

7 ATTACHMENT I Aging Schools Program Fiscal Year 2015 Allocations LEA FY 2015 ASP Allocation Prior FY Unexpended Allocation Total Allocation Available for FY 2015 Allegany $97,791 $595,775 $693,566 Anne Arundel $506,038 $168,452 $674,490 Baltimore City $1,387,924 $72,136 $1,460,060 Baltimore $874,227 $22,631 $896,858 $0 Calvert $38,292 $1,344 $39,636 Caroline $50,074 $41,858 $91,932 Carroll $137,261 $192,835 $330,096 Cecil $96,024 $138,122 $234,146 $0 Charles $50,074 $2,311 $52,385 Dorchester $38,292 $0 $38,292 Frederick $182,622 $17,156 $199,778 Garrett $38,292 $196,160 $234,452 $0 Harford $217,379 $17,224 $234,603 Howard $87,776 $0 $87,776 Kent $38,292 $0 $38,292 Montgomery $602,651 $0 $602,651 $0 Prince George's $1,209,426 $70,977 $1,280,403 Queen Anne's $50,074 $9,554 $59,628 St. Mary's $50,074 $0 $50,074 Somerset $38,292 $233,288 $271,580 $0 Talbot $38,292 $28,720 $67,012 Washington $134,904 $0 $134,904 Wicomico $106,627 $10,846 $117,473 Worcester $38,292 $0 $38,292 Totals $6,108,990 $1,819,389 $7,928,379 * Fiscal Year 2015 allocations are distributed in accordance with the Education Article, Section 5-206(2)(ii) Distribution of Grants - Aging Schools Program. Page 6

8 ATTACHMENT II Eligible Projects\Expenditures and Required Project Approvals All projects require State review, approval and the assignment of a PSC/ASP number prior to award of contract. Any project with a total cost of $100,000 or more requires State approval of the contract award prior to proceeding. Review level submission requirements are as follows: 1 - Abbreviated educational specifications, schematic drawings, design development documents, and construction documents. 2 - Design development documents and construction documents. 3 - Construction documents. 4 - No submissions required after the project is assigned a PSC/ASP number. Review Level ADA accessibility (interior/exterior)... 3 Asbestos and/or lead paint removal/abatement... 4 Bleacher repair and/or replacement (interior only)... 4 Building renovations (interior/exterior)... 2 Carpeting with a 15 year warranty (installation/replacement with VCT)... 4 Ceilings (replacement)... 4 Communication systems (telephone and/or public address)... 4 Career Technology Education program facilities... 1 Doors and/or windows (interior/exterior)... 3 Electrical systems... 3 Elevators... 3 Energy conservation projects... 3 Fire protection systems and/or components (alarms and/or sprinklers)... 3 Flooring materials (repair, replace and/or refinish)... 4 Folding partitions (installation/replacement)... 4 Heating, ventilating, air conditioning systems and/or components... 3 Kindergarten/prekindergarten facilities... 1 Lighting systems and/or components... 3 Masonry work and/or components... 4 Playground equipment... 4 Plumbing, water, and/or sewer lines and fixtures... 4 Renovation projects (related to educational programs/services)... 1 Roofing systems and/or components... 3 Science facilities (middle or high school)... 1 Security improvements... 4 School Library facilities... 1 Site redevelopment... 3 Underground fuel tanks (remove and/or replace)... 4 Wiring schools for technology (voice, video, & data)... 3 ADDITIONAL NOTE: Other projects will be reviewed for eligibility on a case-by-case basis, and required submittals will be specified. Page 7

9 ATTACHMENT III Excerpt from COMAR Regulations for the Administration of the Public School Construction Program 12. Ineligible Expenditures. The following expenditures are ineligible for State funding: A. Site acquisition; B. Offsite development costs except those listed as eligible in Regulation.11G of this chapter; C. Architecture, engineering, or other consultant fees, except as permitted by Regulation.10 of this chapter; D. Master plans, feasibility studies, programs, educational specifications, or equipment specifications; E. Projects proposed in buildings or portions of buildings that have been constructed or renovated within 15 years, except that a building or portion of a building in which a limited renovation was performed is eligible for additional work within 15 years of the date that the limited renovation construction was completed; F. Systemic renovation projects to replace, upgrade, or renovate building systems that have been replaced, upgraded, or renovated within 15 years. G. Ancillary construction costs such as: (1) Permits; (2) Test borings; (3) Soil analysis; (4) Bid advertising; (5) Water and sewer connection charges; (6) Topographical surveys; (7) Models; (8) Renderings; or (9) Cost estimating; H. Leasing or purchasing school facilities except as provided in COMAR ; I. Construction inspection services; J. Relocation costs for site occupants; K. Salaries of local employees; L. Construction of administrative or support facilities, including regional or central administrative offices, warehousing, resource, printing, vehicle storage, and maintenance facilities; M. Movable equipment, furnishings, and artwork as defined by the IAC; N. Maintenance;* and O. Temporary storage. * NOTE: ITEM N. MAINTENANCE IN COMAR IS ELIGIBLE UNDER THE AGING SCHOOLS PROGRAM In any case, where a local board desires to proceed with a capital improvement project, or part thereof, which is ineligible for State funding, the Committee, shall determine the added cost to the approved project generated by the ineligible aspects, and the local board may proceed with the project but without State funding for the added cost.. Page 8

10 ATTACHMENT IV Instructions for Submission of Aging Schools Program (ASP) Application to the PSCP SharePoint Portal **You must use Internet Explorer** Step-by-Step Instructions 1. Download the Aging Schools Program (ASP) application (Excel spreadsheet) from the PSCP website at: 2. Save the application as a document on your computer adding your LEA designation to the file name. Complete the application. See Instructions for Completing the Application for Aging Schools Program Projects. 3. Contact Patrick McGough at pmcgough@msde.state.md.us to obtain a username and password for the SharePoint site; (if you do not already have one). 4. Open Internet Explorer and navigate to: 5. Enter the username and password provided by Patrick McGough. 6. Click on the Programs Site tab. 7. Click on the LEA Document Library on the left sidebar. 8. To upload your completed application and other back-up documentation applicable, click your LEA folder, click the ASP folder, then click Upload and browse to your application or document that you saved in step 2. Click OK and Check in. You will now see a New document in your LEA Aging Schools Program folder. 9. Once an application has been Checked-in PSCP will begin the review process for the IAC Designee approval. 10. After the application is approved the final version of the approved application will be maintained in SharePoint. Any revision requests to the approved projects initiated by the LEA will be made to the application in SharePoint. The revisions should be highlighted in yellow and typed in red font on the application. Additional project requests should be added in the next available row of the application, the absence of an approval date and PSC # will indicate to PSCP that this is a new project request. 11. The LEA should notify Shariece Marine via smarine@msde.state.md.us when the initial application is uploaded and when any revisions or changes to the approval is requested. Page 9

11 ATTACHMENT IV - cont d Instructions for Completing the Application for Aging Schools Program Projects List projects in priority order. The list of projects should not exceed your allocation by more than 10%. Column 1 - Project Name Enter the name of the school and indicate Elementary, Middle, High, or other as appropriate. Column 2 - Type/Description Enter the type of project (i.e., ceiling, masonry work, flooring, roofing - see Attachment II Eligible Project /Expenditures and Required Project Approvals). Describe in detail the existing condition and proposed scope of work. Indicate if project requires replacement of the electrical system or an upgrade of the electrical system. Column 3 - Age Enter the date of construction or latest renovation of the building, system, or component. Column 4 - Anticipated date work: Begins/Completed Enter the anticipated date that the work would begin and the anticipated date for the completion of the work. Column 5 - Method of accomplishing work Enter the method that will be used to accomplish the work (i.e., purchase order, competitive sealed bids, utilize existing time/material contract, utilize existing State/local contract, or describe other method). Column 6 - Method of accomplished design services Enter the method that will be used to accomplish design services (i.e., architect, engineer, inhouse staff, architect/engineer, consultants, or describe other method). Column 7 - LEA Estimate: Total/ASP $ Enter total estimated eligible cost for the project (exclude all ineligible costs including A/E fees) and the ASP funds proposed to be allocated for this project. Since no local matching funds are required for ASP projects, the total cost can be equal to the ASP funds. Total both columns for all projects submitted. Column 8 LEA Local ASP $ Enter total estimated amount of Local funds required for the project, if applicable. Total both columns for all projects submitted. Page 10

12 ATTACHMENT V NOTE: FOR AGING SCHOOLS PROGRAM ONLY IAC/PSCP FORM RE 4000 PROJECT REIMBURSEMENT/EXPENDITURE REPORT LEA: DATE: SCHOOL NAME: PSC/ASP NO: ASP TYPE OF PROJECT: COMPLETION DATE: MAIL PAYMENT TO THE FOLLOWING ADDRESS: TAX ID NUMBER: REQUEST REIMBURSEMENT FOR THE FOLLOWING INVOICES: CONTRACTOR INVOICE NUMBER INVOICE DATE DATE PAID TOTAL PROJECT COST LOCAL COST STATE REQUEST TOTAL NOTE: ATTACH LEGIBLE COPIES OF CANCELED CHECK(S) ATTACH LEGIBLE COPIES OF CONTRACTOR'S INVOICE(S). ATTACH FORM RE4003, MINORITY BUSINESS ENTERPRISE PARTICIPATION ATTACH APPLICABLE MINORITY BUSINESS ENTERPRISE DOCUMENTATION IF CONTRACT AMOUNT WAS GREATER THAN $50,000 AND LESS THAN $99,999 ATTACHMENT A - Certified MBE Utilization and Fair Solicitation Affidavit ATTACHMENT B - MBE Participation Schedule (If there is no overall MBE goal or MBE sub goals established for the project, then only Attachment A is to be included.) ATTACHMENT D - Minority Business Enterprise Subcontractor Project Participation Statement completed and signed by the prime contractor and each MBE firm listed on Attachment B. ATTACHMENT C - Outreach Efforts Compliance Statement signed and completed by the bidder or offeror. ATTACHMENT E - Minority Subcontractors Unavailability Certificate ATTACHMENT F - MBE Waiver Documentation ATTACH BID TAB IF CONTRACT AMOUNT IS $99,999 OR LESS ATTACH CONTRACT OR PURCHASE ORDER IF CONTRACT AMOUNT WAS $99,999 OR LESS I hereby certify that this reimbursement request is for a project previously approved for funding under the State's Aging Schools Program, the project is complete, represents invoices that have been approved for payment by all local responsible persons, is applicable to contractual agreements or purchase orders approved by the Board of Education and is eligible for State funding. I further certify that payment has been made by this Board of Education to the applicable vendor or contractor from funds other than tax-exempt bond proceeds and has not been previously submitted for reimbursement. Signature of LEA Representative Page 11

13 ATTACHMENT VI IAC/PSCP Form Page 3 of 16 CERTIFIED MINORITY BUSINESS ENTERPRISE PARTICIPATION STANDARD MONTHLY CONTRACTOR'S REQUISITION FOR PAYMENT LEA: FACILITY NAME: SCOPE OF WORK: DATE: PSC NO: REQ NO: Name of MBE Sub-Contractor MDOT Certification Number and Classification TOTAL MBE Contract Amount Amount to be Paid THIS Requisition TOTAL Paid to Date MBE has Received FINAL Payment? If amount paid is LESS than TOTAL MBE Contract Amount, EXPLAIN VARIANCE TOTAL: $ - $ - $ - MDOT Certification Number and Classification can be located at MBE Classification: African American = AA Hispanic American = H Native American = N Asian American = A Women = W African American/Women = AAW Hispanic American/Women = HW Native American/Women = NW Asian American/Women = AW I certify that the figures and information presented above represent accurate and true statements, that timely payments have been and will be made to suppliers and subcontractors on this project as requisitioned payments are received, and in accordance with our contracts. Name of Contractor Firm Authorized Contractor Signature/Date Contractor Federal Tax ID # Contractor MBE Classification # (if applicable) Revised March 2013 Page 12

14 ATTACHMENT VI IAC/PSCP Form Page 3 of 16 CERTIFIED MINORITY BUSINESS ENTERPRISE PARTICIPATION STANDARD MONTHLY CONTRACTOR'S REQUISITION FOR PAYMENT Name of LEA MBE Liaison (Printed) Signature of LEA MBE Liaison/Date Instructions for Completion of IAC/PSCP Form Page 3 THIS FORM TO BE COMPLETED BY PRIME CONTRACTOR ONLY 1. LEA Enter full name of LEA. 2. Facility Name Enter full name of school/facility. 3. Scope of Work Enter type of work being performed (i.e. New, Renovation, Roof, HVAC, ASP Flooring, QZAB Media Center, etc.). 4. Date Date of Requisition. 5. PSC NO Enter full PSC Number as assigned by PSCP. 6. REQ NO Enter the number of the corresponding Requisition for Payment. 7. Name of MBE Sub-Contractor Enter full name of MBE Sub-Contractor. 8. MDOT Certification Number & Classification Enter the 5 digit MDOT Certification number and corresponding MDOT Classification for each MBE Sub-Contractor. MDOT Classifications and the MDOT website are listed at the bottom of this form. 9. TOTAL MBE Contract Amount Enter ORIGINAL Total MBE Contract Amount as stated on MBE Attachments B and D. This amount should NOT be altered with change order amounts, changes to scope of work, etc. which may affect contract amount. 10. Amount to be Paid This Requisition Enter the amount to be paid to the MBE Sub-Contractor for work applicable to this requisition. 11. TOTAL Paid to Date Enter the TOTAL amount paid to date to the MBE Sub-Contractor this amount should NOT include the amount being paid on this requisition, only the total of prior payments. 12. MBE has Received FINAL Payment Enter YES if the MBE Sub-Contractor has been paid in full. Enter NO if the MBE Sub-Contractor has NOT been paid in full. 13. If amount paid is LESS than TOTAL MBE Contract Amount, EXPLAIN VARIANCE Enter a brief reason for the MBE Sub-Contractor NOT being paid equal to or greater than the ORIGINAL Total MBE Contract Amount as stated on this form and MBE Attachments B & D. Additional documentation may be required to be submitted for variance explanations. 14. Name of Contractor Firm Enter full name of Prime Contractor. 15. Authorized Contractor Signature/Date The authorized individual employed by the Prime Contractor who filled this form out should date and sign here. 16. Contractor Federal Tax ID # Enter the Federal Tax ID Number of the Prime Contractor. 17. Contractor MBE Classification # - Enter the MDOT MBE Classification Number if the Prime Contractor is a MDOT certified MBE Company. 18. Name of LEA MBE Liaison PRINT the name of the LEA MBE Liaison (or other LEA authorized employee) responsible for VERIFYING ALL INFORMATION filled out by the Prime Contractor on this form. 19. Signature of LEA MBE Liaison/Date Signature of the person VERIFYING ALL INFORMATION filled out by the Prime Contractor on this form (signature of person stated in Step #18.) Revised March 2013 Page 13

15 ATTACHMENT VII CONTRACTOR S CERTIFICATION OF RECEIPT OF PAYMENT IAC/PSCP FORM 306.2a This form must accompany IAC/PSCP Form 306.2, Request for Reimbursement to LEA, if cancelled check(s) are not provided. LEA: PROJECT TITLE: PSC NO: I hereby certify that payment in the amount of $, check number dated, has been received from Public Schools and deposited to (bank) on (date) for capital improvements made to (name of school/project). Name of Contractor Firm Authorized Signature Date NOTARIZATION County, to wit: I hereby certify that on this day of in the year of before me, a Notary Public for said County, personally appeared (name), and made oath in due form of law that he/she is (title) of (name of firm), and on behalf of said firm stated that the matters and facts set forth in the foregoing verification are true to the best of his/her knowledge, information and belief. He/she acknowledged that he/she executed the same purposes herein contained and that they had full authority to execute same. As witness my hand and official seal: NOTARY PUBLIC Page 14

16 ATTACHMENT VIII Page 15