                                                                EPA FORM 6100-2
                           EPA Disadvantaged Business Enterprise (DBE) Program 
                                           DBE Subcontractor Participation Form

An EPA Financial Assistance Agreement Recipient must require its prime contractors to provide this form to its DBE subcontractors. This form gives a DBE[1] subcontractor[2] the opportunity to describe work received and/or report any concerns regarding the EPA-funded project (e.g., in areas such as termination by prime contractor, late payments, etc.).  The DBE subcontractor can, as an option, complete and submit this form to the EPA DBE Coordinator at any time during the project period of performance.

Subcontractor Name

Project Name
Bid/ Proposal No.
Assistance Agreement ID No. (if known)
Point of Contact

Address

Telephone No.

Email Address
Prime Contractor Name
Issuing/Funding Entity:

                             Contract Item Number
Description of  Work Received from the Prime Contractor  Involving Construction,  Services , Equipment or Supplies
                      Amount Received by Prime Contractor

















Please use the space below to report any concerns regarding the above EPA-funded project: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
                            Subcontractor Signature
                                  Title/ date



