Santa Clara — GS-045*

Source: https://santaclara.courts.ca.gov/system/files/forms/gs-045_rem.pdf

SUPERIOR COURT OF CALIFORNIA SANTA CLARA COUNTY

SMALL BUSINESS POST-CONTRACT REPORT

Agreement number:

Contractor name:

The contractor identified above (Contractor) entered into the agreement identified above (Agreement) with the JBE. As required by Government Code section 14841, Contractor must report to the JBE the actual percentage of small/micro-business participation. Please return this form to the JBE within sixty (60) days of receiving final payment under the Agreement. Failure to return this form as required constitutes a breach of the Agreement.

Total amount of money Contractor received under the Agreement

Total amount paid by Contractor to subcontractors that are not DGS-certified small/micro businesses

Contractor certifies that the information above is accurate.

Contractor (Printed) Date Executed

By (Authorized Signature)

Printed Name and Title of Person Signing

Send completed form to: Superior Court of California, Santa Clara County Attn: Procurement Division 191 North First Street San Jose, CA 95113

GS-045 REV 2/4/14