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AGREEMENT NO. C -5 -3632 EXHIBIT D Consultant and the following: 1. Original Contract Amount 2. Running Total of Change Order Amount 3. Current Contract Amount 4. Amount Paid to Consultant during Month 5. Amount Paid to Consultant from Inception to Date 6, DBE Contract Goal 7. Total Dollar Amount of DBE Commitment 8. DBE Commitment as Percentage of Current Contract Amount B. Listed and /Proposed Consultant/Subconsultant Information — For All DBE participation being claimed either Race Neutrally or Race Consciously, regardless of tier; 1. DBE Firm Name, Address, Phone Number, DBE Type of Operation, Certification Type and Certification Number. 2. DBE Firm Contract Value Information: Original contract amount, running total of change order amount, Current contract amount, Amount paid to Consultant during month and Amount paid to Consultant to date. 2. Consultant Assurance of Full Compliance with Prompt Payment Provisions Consultant to sign the prompt payment assurance statement of compliance contained within the Form 103. Consultant is to further maintain and submit at the request of Authority a detailed running tally of related invoices submitted by DBE(s) and Non DBE(s), including dates of invoice submission, dates accepted and corresponding dates and amount of payments made, The Payment and Retention Reporting tally must also include: DBE(s) and Non DBE(s) Invoice Number, Invoice Amount, Invoice Date, Prime Consultant's Invoice Number that incorporated the corresponding DBE and Non DBE invoice(s) for billing purposes, Date of Invoice submission to Authority, Date and amount Authority paid on Prime Consultant's Invoice. The report must also reflect a breakout of retention withheld (including retention as specified in subcontract agreement(s) and disputed invoice retention) and retention payments made, check number and date paid to DBE and Non DBE. Consultant is advised not to report the participation of DBE(s) toward the Consultant's DBE attainment until the amount being claimed has been paid to the DBE. Verification of payments and /or a signed Verification of Payment by the applicable DBE or Non DBE must be submitted with Form 103 to authenticate reported payments. DBE Subcontract Agreements The Consultant must submit to the Authority copies of executed subcontracts and /or purchase orders (PO) for all DBE firms participating on the contract within ten working days of award. The Consultant must immediately notify the Authority In writing of any problems it may have in obtaining the subcontract agreements from listed DBE firms within the specified time. Crancge County Transportation Authority Revised: 05/0612014 25E -30