17. SBPCD.pdf

Small Business Participation Commitment Document (SBPCD) Note: Accepted document to be incorporated in Contract Section J

1. Prime Contractor Size:

Indicate the applicable size and socioeconomic categories -- all that apply:

{ } Other than Small Business or

{ } Small Business also categorized as a { } Small Disadvantaged Business (SDB) { } Woman-Owned Small Business (WOSB) { } Historically Underutilized Business Zone (HUBZone) Small Business { } Service Disabled Veteran Owned Small Business (SDVOSB)

2. Minimum Quantitative Requirement (MQR) -- Participation of Small Businesses*

* CDRL H001, Small Business Participation, reporting applies

Total Contract Value (Awarded)

Minimum Quantitative Requirement (MQR)

Business Category Dollar Value % of Total Contract Value

Total Contract Value – Prime Contractor $ %

Total Small Business $ %

Small Disadvantaged Business $ %

Woman-Owned Small Business $ %

HUBZone Small Business $ %

Veteran-Owned Small Business $ %

Service-Disabled Veteran-Owned Small Business

Ability One (Non-Profit) Small Business $ %

3. Small Business Participants * Changes must be pre-approved by Contracting Officer per: Section H, Special

Contract requirements, paragraph (2).

For Official Use Only – Source Selection Information – See FAR 2.101 and 3.104

Company

Name Business

Category(ies)

(SB, WOSB,

SDB, VOSB,

SDVOSB)

Product(s)/ Service(s) to be

Provided

NAICS

Code

Nature of Commitment