36C25019Q0024-005.pdf

SDVOSB SELF PERFORMANCE

Provide the form below as documentation with each subsequent task order proposal. Reference VAAR 852.219-10.

Calculation of Self Performed Work

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 – 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 SDVOSB Prime Contractor and any SDVOSB Subcontractors.

Calculation of self-performed contract personnel costs:

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

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

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

4. 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.

Name (print and sign) Date

Typed/Printed Title

36C25019Q0024

ATTACHMENT IV