OHIO DEPARTMENT OF TRANSPORTATION

QUARTERLY REPORT OF PAYMENTS MADE TO DBE

(DISADVANTAGED BUSINESS ENTERPRISE)

DUE DATES: JANUARY 10, APRIL 10, JULY 10, OCTOBER 10

Local Let PID# / Local Let Project No:
1st Quarter: ______to ______
2nd Quarter: ______to ______
3rd Quarter: ______to ______
4th Quarter: ______to ______/ DBE Goal %:
Prime Contractor / Project Location:
Federal Tax ID: / Local Let Administrator (County/City/Consultant):
DBE Subcontractor/Fed Tax ID / Payments to Date / Balance Due

Please Print:______

Local Let – DBE/PW/EEO Coordinator LPA – DBE/PW/EEO Coordinator Signature

Date: ____/____/____ Note: Send to the Ohio Department of Transportation District Office, EEO Contract Coordinator - see Listing of Offices on Page 2

1

LPA DBE Quarterly Payments Form

Revised July 2010

ODOT DISTRICT EEO CONTRACT COMPLIANCE OFFICERS & PREVAILING WAGE COORDINATORS

2010

District 1
1885 N. McCullough St.
Lima, Ohio 45801
Phone: 419-222-9055
Fax: 419-222-0438
Robert Habern - (419) 999-6905 EEOCC/DPWC / District 2
317 East Poe Road
Bowling Green, Ohio 43402-1330
Phone: 419-353-8131
Fax: 419-353-1468
Deborah Colbert - (419) 373-4333 EEOCC/DPWC / District 3
906 North Clark St.
Ashland, Ohio 44805
Phone: 800-276-4188
Fax: 419-281-0874
Mary Hodgson - (419) 207-7153 EEOCC/DPWC
District 4
2088 S. Arlington Road
Akron, Ohio 44306
Phone: 330-786-3100 or 800-603-1054
Fax: 330-786-2210
Norma Gonzalez - 330-786-3197 EEOCC
Andrea Aquino - (330) 786-3175 DPWC / District 5
9600 Jacksontown Rd.
Jacksontown, Ohio 43030
Phone: 740-323-4400
Fax: 740-323-3715
Rebecca Starlin - (740) 323-4400 EEOCC/DPWC / District 6
400 East William St.
Delaware, Ohio 43015
Phone: 800-372-7714
Fax: 740-833-8100
Brenda James - (740) 833-8338 EEOCC
Vicki Daas -(740) 833-8042 DPWC
District 7
1001 St. Mary's Ave. SR 29
Sidney, Ohio 45365
Phone: 937-492-1141
Fax: 937-497-9734
Rhonda Voisard – (937) 487-6871 EEOCC/DPWC / District 8
505 South SR 741
Lebanon, Ohio 45036
Phone: 800-831-2142
Fax: 513-932-7651
Danette Shuler - (513) 933-6530 EEOCC/DPWC / District 9
650 Eastern Ave.
Chillicothe, Ohio 45601
Phone: 740-773-2691
Fax: 740-775-4889
Joe Zapata - (740) 774-8835 EEOCC/DPWC
District 10
338 Muskingum Dr.
Marietta, Ohio 45750
Phone: 800-845-0226
Fax: 740-373-7317
Jill Matheny - (740) 568-3930 EEOCC/DPWC / District 11
2201 Reiser Ave.
New Philadelphia, Ohio 44663
Phone: 330-339-6633
Fax: 330-308-3942
Kim Fincher - (330) 308-7815 EEOCC/DPWC / District 12
5500 Transportation Blvd.
Garfield Heights, OH 44125
Phone: 216-581-2100
Fax: 216-587-1730
Tommie Ferrante - (216) 584-2029 DPWC
Sandy Premura – (216) 584-2151 EEOCC

1

LPA DBE Quarterly Payments Form

Revised July 2010