36C25018Q0079-006.docx

Attachment D.3 SDVOSB Self-Performance Certification

Provide the form below as documentation with each quote. Reference VAAR 852.219-10.

SDVOSB Company: ____________________________

Provide the following information to identify and calculate the cost of the work to be self-performed. Refer to the definitions pertaining to self-performance of work which is part of solicitation provision VAAR 852.219-10, VA Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside (c) ‘A service-disabled Veteran-owned small business concern agrees that in the performance of the contract, the concern will comply with the limitation on subcontracting requirements in 13 CFR §125.6 – excerpt below:

1) In the case of a contract for services (except construction), the concern will not pay more than 50% of the amount paid by the government to it to firms that are not similarly situated.

2) In the case of a contract for supplies or products (other than from a nonmanufacturer of such supplies), it will not pay more than 50% of the amount paid by the government to it to firms that are not similarly situated.

Clearly describe the work to be self-performed to include personnel, tasks, supplies and/or products provided by SDVOSB Prime Contractor and all Subcontractors.

Supplies and/or Products Cost

Calculation of self-performed contract costs:

Total subcontractor costs that are not SDVOSB companies that will perform work on this contract

Subtract Line 2 from Line 1 – This is the total amount of work to be self-performed under the Contract.

Costs include all costs directly charged to the project.

I certify the above representations are true and correct to the best of my knowledge.

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