36C25219Q0956-003.docx

Instructions

Complete one (1) of the following documents:

· Contractor Performs 100% of Work

· Complete if offeror does not intend any of the work to be Subcontracted.

· Overview of Contractor and Subcontractor Work

· Complete if offeror intends to use Subcontractor(s).

Not submitting one (1) of the following documents with your package may result in an offeror to be determined non-responsible.

Contractor Performs 100% of Work

Please complete and return this overview to the undersigned via e-mail if no subcontractors are utilized in performing services under this contract, complete the below certification and submit with your package.

Reference: Solicitation No. Title:

My employees perform 100% of the work required on this contract.

Company Name: ______________________________

Name and Title of Signer: ______________________________

Signature: ______________________________

Confirmation of Percentage of Work Performed by Contractor

Overview of Contractor and Subcontractor Work

Reference: Solicitation No. Title:

SDVOSB/VOSB Company:

Please provide the following information to identify and calculate the cost of the work self- performed and what is subcontracted.

Clearly describe the work self-performed and the work to be subcontracted. Description to include trade descriptions, equipment, equipment maintenance, percentage of personnel, percentage of supervision, etc., and work to be performed. For each subcontractor provide their business name, address, phone number, and DUNs Number if available.

Percentage of Description of Work Contractor Contract Services

Total percentage of work performed by (prime contractor)

Total percentage of work performed by subcontractors

Calculation of self-performed contract personnel costs:

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

2. Subtract all subcontractor personnel costs* that will perform work on this contract

3. Remainder is ‘Total amount of work to be self-performed under the Contract’

4. Self-performed work = Line 3/Line 1 X 100 = %

*personnel costs include laborers, mechanics, other tradesmen, and office personnel directly charged to the contract.

I certify the above representations are true and correct to the best of my knowledge. Contractor Signature: Date:

Title: