36C25018Q9389-003.docx

VOSB SELF PERFORMANCE

Provide the form below as documentation with each subsequent task order proposal. Reference VAAR 852.219-11.

Calculation of Self Performed Work

VOSB 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 852.219-11 VA NOTICE OF TOTAL VETERAN-OWNED SMALL BUSINESS SET-ASIDE – excerpts below:

(a) (1) In the case of a contract for services (except construction), it will not pay more than 50% of the amount paid by the government to it to firms that are not similarly situated. Any work that a similarly situated subcontractor further subcontracts will count towards the 50% subcontract amount that cannot be exceeded.

Clearly describe the work to be self-performed to include number of personnel and work to be performed by VOSB Prime Contractor and any VOSB Subcontractors.

Calculation of self-performed contract personnel costs:

1. Total personnel costs* both prime and all subcontractors: $____________________

1. Subtract all subcontractor personnel costs* that are not VOSB companies that will perform work on this contract $_________________________

1. Remainder is ‘Total amount of work to be self-performed and similarly situated subcontractor under the Contract” $______________________

1. Self-performed work = _____% *personnel costs include personnel directly charged to the project.

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

Typed/Printed Title