<p> Design and Construction </p><p>Office of Minority and Women-Owned Business Enterprises, 35th Floor, Corning Tower The Governor Nelson A. Rockefeller Empire State Plaza Albany, New York 12242 Phone: (518) 473-7083 FAX: (518) 486-2679 </p><p>CONTRACTOR’S CUMULATIVE MONTHLY EMPLOYMENT UTILIZATION REPORT Project No. 1. Name and Address of Firm: 2. Check Appropriate Box: 3. Current Goals: 4. Firm Designated As: 5. Reporting Period</p><p>Prime Contractor Minority % MBE Yes No Month Year</p><p>Subcontractor Female % WBE Yes No </p><p>6. Project Location: 7. Project Description: Federal ID No.: Total Work Hours of Employment</p><p>8. Construction Trade 9. Employee 9a. Total of All 9b. Black 9c. Hispanic 9d. Asian 9e. American Indian 10. 11. 12. Total Number of 13. Total Number of Classification Employees By Trade (Not of Hispanic or Pacific Islanders or Alaskan Native %Min. %Fem. Employees Minority Employees Origin)</p><p>M F M F M F M F M F M F M F M F Professionals Field Office Staff Technicians Clerical Sub-Total Foreperson Journey Worker Apprentice Sub-Total Foreperson Journey Worker Apprentice Sub-Total Foreperson Journey Worker Apprentice Sub-Total Foreperson Journey Worker Apprentice Sub-Total 14. Total Field Staff Total Forepersons Total Journey Workers Total Apprentices 15. Grand Total </p><p>Signature of Firm’s Affirmative Action Officer Print Name Date Telephone No.</p><p>For OGS Use Only This report is required pursuant to contract specifications. Failure to submit will result in noncompliance with contract Reviewed by: Date: specifications.</p><p>BDC 19 (04/03)</p>