Common use of Reporting Entity Clause in Contracts

Reporting Entity. □ Contractor □ Subcontractor Reporting Period: □ January 1, 20_ - March 31, 20 □ April 1, 20 - June 30, 20_ □ July 1, 20_ - September 30, 20 □ October 1, 20_ - December 31, 20_ Contractor’s Name: Report includes: □ Work force to be utilized on this contract □ Contractor/Subcontractor’s total work force Contractor’s Address: Enter the total number of employees in each classification in each of the EEO-Job Categories identified. EEO-Job Category Total Work force Work force by Gender Work force by Race/Ethnic Identification Male (M) Female (F) White (M) (F) Black (M) (F) Hispanic (M) (F) Asian (M) (F) Native American (M) (F) Disabled (M) (F) Veteran (M) (F) Officials/Administrators Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Service Workers Temporary /Apprentices Totals PREPARED BY (Signature): TELEPHONE NO.: EMAIL ADDRESS: DATE: NAME AND TITLE OF PREPARER (Print or Type): Submit completed form to: NYS Governor’s Office of Storm Recovery, 00 Xxxxxx Xxxxxx, 0xx Xxxxx, Xxx Xxxx, XX 00000, or XXXX_XXXXxxxxxxx@xxxxxxxxxxxxx.xx.xxx

Reporting Entity. □ Contractor □ Subcontractor Reporting Period: □ January 1, 20_ - March 31, 20 □ April 1, 20 - June 30, 20_ □ July 1, 20_ - September 30, 20 □ October 1, 20_ 20 - December 31, 20_ 20 Contractor’s Name: Report includes: □ Work force to be utilized on this contract □ Contractor/Subcontractor’s total work force Contractor’s Address: Enter the total number of employees in each classification in each of the EEO-Job Categories identified. EEO-Job Category Total Work force Work force by Gender Work force by Race/Ethnic Identification Male (M) Female (F) White (M) (F) Black (M) (F) Hispanic (M) (F) Asian (M) (F) Native American (M) (F) Disabled (M) (F) Veteran (M) (F) Officials/Administrators Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Service Workers Temporary /Apprentices Totals PREPARED BY (Signature): TELEPHONE NO.: EMAIL ADDRESS: DATE: NAME AND TITLE OF PREPARER (Print or Type): Submit completed form to: NYS Governor’s Office of Storm Recovery, 00 Xxxxxx Xxxxxx, 0xx Xxxxx, Xxx Xxxx, XX 00000, or XXXX_XXXXxxxxxxx@xxxxxxxxxxxxx.xx.xxx

Reporting Entity. □ Contractor □ Subcontractor Reporting Period: □ January 1, 20_ - March 31, 20 □ April 1, 20 - June 30, 20_ □ July 1, 20_ - September 30, 20 □ October 1, 20_ 20 - December 31, 20_ 20 Contractor’s Name: Report includes: □ Work force to be utilized on this contract □ Contractor/Subcontractor’s total work force totalworkforce Contractor’s Address: Enter the total number of employees in each classification in each of the EEO-Job Categories identified. EEO-Job Category Total Work force Work force by Gender Work force by Race/Ethnic Identification Male (M) Female (F) White (M) (F) Black (M) (F) Hispanic (M) (F) Asian (M) (F) Native American (M) (F) Disabled (M) (F) Veteran (M) (F) Officials/Administrators Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Service Workers Temporary /Apprentices Totals PREPARED BY (Signature): TELEPHONE NO.: EMAIL ADDRESS: DATE: NAME AND TITLE OF PREPARER (Print or Type): Submit completed form to: NYS Governor’s Office of Storm Recovery, 00 Xxxxxx Xxxxxx, 0xx Xxxxx, Xxx Xxxx, XX 00000, or XXXX_XXXXxxxxxxx@xxxxxxxxxxxxx.xx.xxx

Reporting Entity. □ Contractor □ Subcontractor Reporting Period: □ January 1, 20_ - March 31, 20 □ April 1, 20 - June 30, 20_ □ July 1, 20_ - September 30, 20 □ October 1, 20_ - December 31, 20_ Contractor’s Name: Report includes: □ Work force to be utilized on this contract □ Contractor/Subcontractor’s total work force Contractor’s Address: Enter the total number of employees in each classification in each of the EEO-Job Categories identified. EEO-Job Category Total Work force Work force by Gender Work force by Race/Ethnic Identification Male (M) Female (F) White (M) (F) Black (M) (F) Hispanic (M) (F) Asian (M) (F) Native American (M) (F) Disabled (M) (F) Veteran (M) (F) Officials/Administrators Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Service Workers Temporary /Apprentices Totals PREPARED BY (Signature): TELEPHONE NO.: EMAIL ADDRESS: DATE: NAME AND TITLE OF PREPARER (Print or Type): Submit completed form to: NYS Governor’s Office of Storm Recovery, 00 Xxxxxx 25 Bxxxxx Xxxxxx, 0xx Xxxxx, Xxx Xxxx, XX 00000, or xx XXXX_XXXXxxxxxxx@xxxxxxxxxxxxx.xx.xxx

Reporting Entity. □ Contractor □ Subcontractor Reporting Period: □ January 1, 20_ - March 31, 20 □ April 1, 20 - June 30, 20_ □ July 1, 20_ - September 30, 20 □ October 1, 20_ 20 - December 31, 20_ 20 Contractor’s Name: Report includes: □ Work force to be utilized on this contract □ Contractor/Subcontractor’s total work force workforce Contractor’s Address: Enter the total number of employees in each classification in each of the EEO-Job Categories identified. EEO-Job Category Total Work force Work force by Gender Work force by Race/Ethnic Identification Male (M) Female (F) White (M) (F) Black (M) (F) Hispanic (M) (F) Asian (M) (F) Native American (M) (F) Disabled (M) (F) Veteran (M) (F) Officials/Administrators Professionals Technicians Sales Workers Office/Clerical Craft Workers Laborers Service Workers Temporary /Apprentices Totals PREPARED BY (Signature): TELEPHONE NO.: EMAIL ADDRESS: DATE: NAME AND TITLE OF PREPARER (Print or Type): Submit completed form to: NYS Governor’s Office of Storm Recovery, 00 Xxxxxx Xxxxxx, 0xx Xxxxx, Xxx Xxxx, XX 00000, or XXXX_XXXXxxxxxxx@xxxxxxxxxxxxx.xx.xxx