ATT 7_SBPCD Template 4-13-20.pdf

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Attached to
Federal Flexible Spending Account (FSAFEDS) Program Services
Solicitation number
24361820R0002
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Text version

RFP 24368120R0002

ATTACHMENT 7

SMALL BUSINESS PARTICIPATION COMMITMENT DOCUMENT

(SBPCD)

Company Name:

(PRIME OFFEROR)

DUNS #:

1. Prime Contractor Business Size:

(Relative to the NAICS code and small business size standard listed in the solicitation) Indicate the applicable size and socioeconomic categories, mark all that apply:

Other than Small Business (includes Large business) Small Business (SB) (also check any of the below as applicable) Small Disadvantaged Business (SDB) Woman-Owned Small Business (WOSB) Historically Underutilized Business Zone (HUBZone) Small Business Service-Disabled Veteran Owned Small Business (SDVOSB) SBA 8(a) Business Development Program Participant Other Small Business Socioeconomic Categories (LIST)

2. Complete the table below for all Small Business (SB) Participation. List principal supplies/services to be performed or provided by Small Businesses, and nature of commitment.1 SB Company Name

DUNS#2 SB

Categories3

NAICS Product(s) / Service(s) to be Provided4, and Period(s) of Performance5

Nature and Level of Commitment6

Copies of any commitment agreements should be provided as an attachment to your SBPCD and will not count against any page limitations.

1 Add rows as needed.

2 DUNS # as registered in SAM.gov 3 SB, WOSB, SDB, SDVOSB, 8(a), etc.

4 Reference any categories of labor or services referenced in the PWS 5 Periods of Performance as noted in the PWS 6 Describe the extent of commitment to use small businesses specifically, what types of commitments, if any, are in place for this specific acquisition. Is the prime a small business? If so state “PRIME” in this column. Is there a written contract between prime and this small business? Is it verbal? Is it enforceable or non-enforceable? Is there a joint venturing or mentor-protégé arrangement?

3. Insert the following figures from your Attachment 2, Quote Schedule to illustrate the Proposed

Total Contract Value (TCV):

CLIN # & Description As noted on “Unit Pricing” Tab

As noted on “Opt Debit Card Unit Pricing” Tab

CLIN 00001 – Start Up Services

CLIN 00002 – Subtotal Base Period One

CLIN 00003 – Subtotal Base Period Two

CLIN 00004 – Subtotal Base Period Three

CLIN 10001 – Subtotal Option Period One

Proposed TOTAL CONTRACT VALUE (Sum of CLINS 00001 through 10001)

4. Of the Proposed Total Contract Values (TCVs) noted in Item 2 above, identify the proposed dollar values and percentages that will be performed by the Prime Offeror versus Subcontractors. All percentages should use Proposed Total Contract Values (TCV) as a reference. Include ALL Subcontractors. 7

In Reference to “Unit

Pricing” Tab TCV In Reference to “Opt Debit Card Unit Pricing” Tab TCV

Amount to be performed by the PRIME Contractor

Percentage to be Performed by the PRIME Contractor8

Amount to be performed by Subcontractors $ $ Percentage to be Performed by Subcontractors % % Proposed TOTAL CONTRACT VALUE9 $ $ Percentage Totals10 % %

7 Show Percentages with no more than two decimal places (0.00%) 8 If the PRIME is a Small Business, the percentage of work to be performed by the prime must not be less than 51% in either column.

9 The SUM of the dollar amounts for PRIME and Subcontractors in the table must total the Proposed TCVs in Item 2 above.

10 Percentage totals for PRIME and Subcontractors must total 100%

5. Of the Proposed Total Contract Values (TCVs) noted in Item 2 above, identify the proposed dollar values and percentages that will be performed by Small Business versus Other than Small Business (regardless of business size). All percentages should use Proposed Total Contract Values (TCV) as a reference. 11

In Reference to “Unit

Pricing” Tab TCV In Reference to “Opt Debit Card Unit Pricing” Tab TCV

Amount to be performed by SMALL

BUSINESSES 12

Percentage to be Performed by SMALL

BUSINESSES1314

Amount to be performed by OTHER THAN

SMALL BUSINESSES

Percentage to be Performed by OTHER THAN

SMALL BUSINESSES

Proposed TOTAL CONTRACT VALUE15 $ $ Percentage Totals16 % %

11 Show Percentages with no more than two decimal places (0.00%) 12 A Prime that is a Small Business itself shall include its own participation as the prime when noting the Amount to be performed by Small Business.

13 A Prime that is a Small Business itself shall include its own participation as the prime when noting the Percentage to be performed by Small Business.

14 Percentages to be performed by Small Business must meet or exceed the Baseline Percentage noted in the Solicitation 15 The SUM of the dollar amounts for SMALL and Other than Small in the table must total the Proposed TCVs in Item 2 above.

16 Percentage totals for SMALL and Other than Small must total 100%

6. Of the Proposed Total Contract Values (TCVs) noted in Item 2 above, identify the proposed dollar values and percentages that will be performed by the following socioeconomic categories of Small Businesses. All percentages should use Proposed Total Contract Values (TCV) as a reference. 17 18 19

In Reference to “Unit Pricing” Tab TCV

In Reference to “Opt Debit Card Unit Pricing” Tab TCV

Amount to be performed by SMALL

DISADVANTAGED BUSINESS (SDB)

Percentage to be Performed by SMALL

DISADVANTAGED BUSINESS (SDB)

Amount to be performed by WOMAN OWNED SMALL

BUSINESSES (WOSB)

Percentage to be Performed by WOMAN OWNED

SMALL BUSINESSES (WOSB)

Amount to be performed by HUBZONE SMALL

BUSINESSES

Percentage to be Performed by HUBZONE SMALL

BUSINESSES

Amount to be performed by SERVICE DISABLED

VETERAN OWNED SMALL BUSINESSES (SDVOSB)

Percentage to be Performed by SERVICE DISABLED

VETERAN OWNED SMALL BUSINESSES (SDVOSB)

Amount to be performed by SBA 8(a) Small Business Development Program Participants

Percentage to be Performed by SBA 8(a) Small Business Development Program Participants

Amount to be performed by all other Small Business Socioeconomic Categories

Percentage to be Performed by all other Small Business Socioeconomic Categories

List of all other Small Business Socioeconomic Categories to be utilized:

17 Show Percentages with no more than two decimal places (0.00%) 18 A Prime that is a Small Business itself shall include its own participation as the prime when noting the Amount to be performed by any socioeconomic category.

19 Leave no spaces blank. Use Zeroes ($0.00 or 0.00%) to show no participation.

File details come from the government source that posted it. Updated .