Amendment A00001 USCG_Subcontracting_Plan_Template.docx
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- Floating Crane Services
- Solicitation number
- 70Z04025Q62401Y00
About this file
This is a Small Business Subcontracting Plan template provided by the U.S. Coast Guard (USCG) for contractors to use when submitting subcontracting plans pursuant to FAR 52.219-9(d). The template is required for contracts valued at $750,000 or greater ($1.5M for construction) that have subcontracting possibilities and are awarded to other than small businesses.
The template requires contractors to provide detailed information including subcontracting goals aligned with USCG's targets (43% Small Business, 5% Small Disadvantaged Business, 3% HUBZone, 3% Service-Disabled Veteran-Owned Small Business, 5% Woman-Owned Small Business), descriptions of products/services to be subcontracted, methods for identifying potential sources, and designation of a Subcontracting Program Administrator. It includes sections for reporting requirements through the Electronic Subcontracting Reporting System (eSRS), recordkeeping requirements, and assurances of good faith effort to meet subcontracting goals. This is strictly a template document and does not contain specific contract requirements or objectives.
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Other files
| File | Type | Posted |
|---|---|---|
| SF1449 - Solicitation for Commercial Products and Commercial Services.pdf | ||
| Amendment A0001 SF30..doc | DOC document | |
| SF1449_70Z04025Q62401Y00 Floating Crane Services.pdf | ||
| Attachment (2) DOL 2015-4265 r27 7.22.24.pdf | ||
| RFQ 70Z04025Q62401Y00 11.8.24.docx | DOCX document | |
| Atch (a) SFLC-Std-Spec-8634-(2020).pdf | ||
| Attachment (1) FLOATING CRANE SOW Rev. 11.8.24.docx | DOCX document |
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SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE
(Also see Federal Acquisition Regulation 19.704 and 52.219-9)
This template is a suggested model for use when formulating a subcontracting plan to be submitted for United States Coast Guard (USCG) solicitations pursuant to the requirements at FAR 52.219- 9(d). While this template has been designed to be consistent with Federal Acquisition Regulation (FAR) 19.704, the use of this template DOES NOT waive other requirements that are applicable under FAR 52.219-9 and specified in the Government’s solicitation. This template is not intended to replace any existing Corporate / Commercial Plan that may be more extensive. However, failure to include the essential information as set forth in this model may be cause for either a delay in acceptance or the rejection of an offer where the clause is applicable. Further, the use of this model is not intended to waive other requirements that may be applicable under FAR 52.219-9 or that may appear in the Government’s solicitation. "SUBCONTRACT," as used in 52.219-9, refers to your external company spend, meaning any agreement (other than one involving an employer-employee relationship) entered into by a federal government prime contractor or subcontractor calling for supplies or services required for performance of the contract or subcontract.
A Subcontracting Plan is required if the estimated cost of the contract is equal to or greater than $750,000 ($1,500,000 for construction), and the contract has subcontracting possibilities, and the award is made to an “Other Than Small Business”. See FAR 19.702 for exemptions.
SOLICITATION NUMBER: ___________________________________________
CONTRACT VEHICLE (Select One and Delete remainder):
· STAND-ALONE CONTRACT ___
· INDEFINITE DELIVERY VEHICLE (IDV) ___
· FEDERAL SUPPLY SCHEDULE ORDER ___
· CONTRACT MODIFICATION ___
Note: FAR 19.702(e): A contract may not have more than one subcontracting plan. However, a contracting officer may establish separate subcontracting goals for each order under an indefinite-delivery, indefinite-quantity contract (19.705-1(b)(2)). When a contract modification exceeds the subcontracting plan threshold (see 19.702(a)) or an option is exercised. The goals of an existing subcontracting plan shall be amended to reflect any new subcontracting opportunities not envisioned at the time of contract award. The goal changes do not apply retroactively.
DATE OF PLAN SUBMISSION: ________________________________________
CONTRACTOR: ____________________________________________________
ADDRESS: ________________________________________________________
STATE/ZIP CODE___________________________________________________
UNIQUE ENTITY IDENTIFYIER (UEI): _____________________________
ITEM/SERVICE (Description/Title of Requirement): ___________________________________
NEW / INITIAL CONTRACT
PERIOD OF CONTRACT PERFORMANCE (MM/DD/YYYY – MM/DD/YYYY):_______ - _________
Base (if options apply) $___________________ Performance Period/Quantity ___________
Option 1: $___________________ Performance Period/Quantity ____________
Option 2: $___________________ Performance Period/Quantity ____________
Option 3: $___________________ Performance Period/Quantity ____________
Option 4: $___________________ Performance Period/Quantity ____________
$___________________ Total Contract Cost
CONTRACT MODIFICATION (if applicable)
NEW PERIOD OF CONTRACT PERFORMANCE (MM/DD/YYYY – MM/DD/YYYY):__________________
Original/Base $___________________ Performance Period/Quantity _________
Modification $___________________ Performance Period/Quantity _________
Task Order $___________________ Performance Period/Quantity _________
$___________________ Modified Total Contract Cost
Important: Failure to include information covered by FAR 52.2199 may be cause for either a delay in acceptance or rejection of a bid or offer when a subcontracting plan is required. The term “SUBCONTRACT,” as used in this clause, means any agreement (other than one involving an employeremployee relationship) entered into by a Federal Government prime contractor or subcontractor involving supplies or services required for performance of a contract or subcontract.
If assistance is needed to help locate small business sources, please contact the small business administration.
USCG’s Subcontracting Goals are:
| Small Business (SB) |
| 43.00% |
| Small Disadvantaged Businesses (SDB, includes Section 8(a) firms) |
| 5.00% |
| Historically Underutilized Business Zone Small Business (HUBZone) |
| 3.00% |
| Service-Disabled Veteran Owned Small Business (SDVOSB) |
| 3.00% |
| Woman-Owned Small Business (WOSB) |
| 5.00% |
Note: The Small Business Administration defines a small business concern as one that is independently owned and operated, organized for profit, and is not dominant in its field. The small business designation is also governed by industry size standards, the average number of employees for the preceding twelve months to include sales volume averaged over a three-year period. See www.sba.gov for additional information regarding size standards.
1. Type of Plan (check one)
[Note: Almost all plans submitted to USCG should be Individual Plans.]
_____ Individual plan means a subcontracting plan that covers the entire contract period of performance (including options, if applicable), applies to a specific contract, and contains goals that are based on the offeror’s planned subcontracting in support of the specific contract, except that indirect costs incurred for common or joint purposes may be allocated on a prorated basis to the contract. Plan Expiration:___________
_____ Master plan means a subcontracting plan that includes all the required elements of an individual contract plan, except goals, and may be incorporated into individual contract plans, provided the master plan has been approved. Plan Expiration:___________
_____ Commercial products/service plan means a subcontracting plan (including goals) that covers the offeror’s fiscal year and the plan applies to the entire production of commercial items sold by either the entire company or a portion thereof ( e.g., division, plant, or product line). Plan Expiration:___________
2. Goals
Below report the dollar and percentage goals for Small Business (SB), Small Disadvantaged (SDB) including Alaska Native Corporations and Indian Tribes, Womenowned and Economically Disadvantaged Women-Owned (WOSB), Historically Underutilized Business Zone (HUBZone), Veteran Owned Small Business (VOSB), Service-Disabled Veteran-Owned (SDVOSB) Small Businesses and “Other than Small Business” (Other) as subcontractors. Indicate the base year and each option year, as specified in FAR 19.704 or project annual subcontracting base and goals under commercial plans. If any contract contains more than four options, please attach additional sheets which illustrate dollar amounts and percentages. PLEASE NOTE: Zero dollars is not an acceptable goal for SB, SDB, WOSB, HUBZone, VOSB or SDVOSB categories because FAR 19.702 requires contractors to demonstrate a good faith effort throughout the period of performance of the contract. Percentages may be rounded to nearest tenth of a percent. INCLUDE SUPPORTING RATIONALE FOR ALL PROPOSED GOALS AND ENSURE THIS PLAN IS CONSISTENT WITH ANY SMALL BUSINESS PARTCIPATION AND COMMITMENT STRATEGY ASSOCIATED WITH THIS ACQUISITION. (Can be a table or description as noted below.)
a. Total estimated dollar value of ALL planned subcontracting, i.e., with ALL types of concerns under this contract is $ ________________ (Recommend tabular format breakdown by Base Period + All Option Periods).
b. Total estimated dollar value and percent of planned subcontracting with SMALL BUSINESSES (including SDB, WOSB, HUBZone, VOSB and SDVOSB, ANC and Indian Tribes): (% of “a”) $ ________________ (Recommend tabular format breakdown by Base Period + All Options Periods)
c. Total estimated dollar value and percentage of planned subcontracting with SMALL DISADVANTAGED BUSINESSES: (% of “a”) $ ________________ (Recommend tabular format breakdown by Base Period + All Option Periods)
d. Total estimated dollar value and percentage of planned subcontracting with WOMENOWNED SMALL BUSINESSES: (% of “a”) $ ________________ (Recommend tabular format breakdown by Base Period + All Option Periods)
e. Total estimated dollar and percentage of planned subcontracting with HUBZone SMALL BUSINESSES: (% of “a”) $ ________________ and (Recommend tabular format breakdown by Base Period + All Option Periods)
f. Total estimated dollar and percentage of planned subcontracting with VETERAN-OWNED SMALL BUSINESSES: (% of “a”) $ ____________ (Recommend tabular format breakdown by Base Period + All Option Periods)
g. Total estimated dollar and percentage of planned subcontracting with SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESSES: (% of “a”) $ ________________ (Recommend tabular format breakdown by Base Period + All Option Periods)
h. Total estimated dollar and percentage of planned subcontracting with “OTHER THAN SMALL BUSINESSES” (As defined by the Small Business Administration as “any entity that is not classified as a U.S. small business. This includes large businesses, state and local governments, non-profit organizations, public utilities, educational institutions and foreign-owned firms.)
i. (% of “a”) $ ________________ (Recommend tabular format breakdown by Base Period + All Option Periods)
3. Products and/or Services (See FAR 19.704(a)(3)
Provide a description of ALL products and/or services to be subcontracted under this contract and percentage (%) of work. It is important to identify and report the name and socio-economic status of the entities to be utilized as subcontractors, and indicate what (if any) written commitments have been entered into with the subcontractors.
The types of products and/or services to be subcontracted are:
LB:
SB:
VO:
SDVO:
SDB:
WO:
HUB:
4. Goal Development (See FAR 19.704(a)(4))
Provide a description of the method used to develop the subcontracting goals for SB, SDB, WOSB, HUBZone, VOSB, and SDVOSB concerns. Include a statement explaining how the products and services to be subcontracted were established, how the products and services to be subcontracted to SB, SDB, WOSB, HUBZone, VOSB, SDVOSB concerns were determined, and how their capabilities were assessed.
5. Identifying Potential Sources (See FAR 19.704(a)(5))
Address efforts made to ensure that maximum practicable subcontracting opportunities have been made available for those concerns and explain the method used to identify potential sources for solicitation purposes. Explain how the areas to be subcontracted to SB, WOSB, HUBZone, VOSB and SDVOSB concerns were determined, how the capabilities of these concerns were considered contract opportunities and how such data comports with the cost proposal. Identify any source lists or other resources used in the determination process. The offeror may rely on the information contained in SAM as an accurate representation of a concern’s size and ownership characteristics for the purposes of maintaining a SB, VOSB, SDVOSB, HUBZone, SDB, and WOSB source list. Use of SAM as a source list does not relieve the offeror of its responsibilities (e.g., outreach, assistance, counseling, or publicizing subcontracting opportunities.
6. Indirect Costs (See FAR 19.704(a)(6))
a. Indirect costs have ____ or have not ____ been included in the dollar and percentage subcontracting goals above (check one).
b. If indirect costs have been included, explain the method used to determine the proportionate share of such costs to be allocated as subcontracts to SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns:
7. Subcontracting Program Administrator and Duties (See FAR 19.704(a)(7)):
NAME: ______________________________________________
TITLE: ______________________________________________
| ADDRESS: | ______________________________________________ | |
| ______________________________________________ |
TELEPHONE: ______________________________________________
E-MAIL: ______________________________________________
This individual has general overall responsibility for the company's small business program. This person should have knowledge of the federal small business programs and be knowledgeable about federal procurement practices. If the prime decides to change the person in this position, they must notify the Contracting Officer. The administrator is responsible for the development, preparation and execution of this subcontracting plan, and for monitoring performance relative to contractual subcontracting requirements contained in this plan, including:
1. Developing and maintaining bidders lists of SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB concerns, AbilityOne program participants, HBCU/MIs, ANCs, and Indian Tribes (hereafter referred to as the small business community) from all possible sources.
1. Counsel and discuss subcontracting opportunities with representatives of the small business community.
| c. | Ensuring that procurement packages are structured to permit the small business community to participate to the maximum extent possible. |
| d. | Assuring inclusion of the small business community in all solicitations for products or services, which they are capable of providing. |
| e. | Reviewing solicitations to remove statements, clauses, etc., which may tend to restrict or prohibit the small business community participation. |
| f. Assign each subcontract the NAICS code and corresponding size standard that best describes the principal purpose of the subcontract. | |
| g. Confirm that a subcontractor representing itself as a HUBZone small business concern is certified by SBA as a HUBZone small business concern by SBA in accordance with 52.219-8(d)(2) | |
| h. Provide notice to subcontractors concerning penalties and remedies for misrepresentations of business status as small, veteran-owned small business, HUBZone small, small disadvantaged, or women-owned small business for the purpose of obtaining a subcontract that is to be included as part or all of a goal contained in the subcontracting plan. | |
| i. | Ensuring periodic rotation of potential subcontractors on bidders lists. |
| j. | Ensuring that the bid proposal review board documents its reasons for not selecting low bids submitted by the small business community. |
| k. | Ensuring the establishment and maintenance of records of solicitations and subcontract award activity. |
| l. | Attending or arranging for attendance of company counselors at Business Opportunity Workshops, Minority Business Enterprise Seminars, Trade Fairs, etc. |
| m. | Conducting or arranging for the motivational training for purchasing personnel pursuant to the intent of P.L. 95-507. |
| n. | Monitoring attainment of proposed goals. |
| o. | Preparing and submitting required periodic subcontracting reports. |
| p. | Coordinating contractor's activities during the conducting of compliance reviews by Federal agencies. |
| q. | Coordinating the conduct of contractor's activities involving its small business subcontracting program. |
| r. | Additional duties: (list any additional duties) |
8. Equitable Opportunity (See FAR 19.704(a)(8))
<Insert Vendor Name> will undertake appropriate efforts to ensure that SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns will have an equitable opportunity to compete for subcontracts. These efforts include, but are not limited to, the following activities:
a. Outreach efforts to obtain sources:
1. Contact minority and small business trade associations
2. Contact business development organizations and local chambers of commerce
3. Attend SB, SDB, WOSB, HUBZone, VOSB and SDVOSB procurement conferences and trade fairs
4. Review sources from the Dynamic Small Business Search web page (http://dsbs.sba.gov/dsbs/search/dsp_dsbs.cfm)
5. Review sources from the System for Award Management web page (www.sam.gov)
6. Review sources from the U.S. Department of Veterans Affairs, Vendor Information Pages VIP at: https://www.vip.vetbiz.va.gov/
Additional efforts: _________________________________________________
b. Internal efforts to guide and encourage purchasing personnel:
1. Conduct workshops, seminars and training programs;
2. Establish, maintain, and utilize SB, SDB, WOSB, HUBZone, VOSB and SDVOSB source lists, guides, and other data for soliciting subcontractors; and
3. Monitor activities to evaluate compliance with the subcontracting plan.
Additional efforts: ______________________________________________________________
9. Flow-Down Clause (See FAR 19.704(a)(9))
<Insert Vendor Name> agrees to include the FAR clause 52.219-8 entitled "Utilization of Small Business Concerns " in all subcontracts which offer further subcontracting opportunities, and all subcontractors, except SB concerns, that receive subcontracts in excess of $750,000 ($1,500,000 for construction) will be required to adopt plans that comply with the requirements of the clause at 52.219-9, Small Business Subcontracting Plan. Such plans will be reviewed by comparing them with the provisions of P.L. 95-507 and assuring that all minimum requirements of an acceptable subcontracting plan have been satisfied. The acceptability of percentage goals shall be determined on a case-by-case basis depending on the supplies/services involved, the availability of potential small and small disadvantaged subcontractors, and prior experience. Once approved and implemented, plans will be monitored through the submission of periodic reports, and/or, as time and availability of funds permit, periodic visits to review subcontracting program progress.
10. Reporting and Cooperation (See FAR 19.704(a)(10))
<Insert Vendor Name> agrees to,
(i) Cooperate in any studies or surveys as may be required;
(ii) Submit periodic reports so that the Government can determine the extent of compliance by the offeror with the subcontracting plan;
(iii) After November 30, 2017, include subcontracting data for each order when reporting subcontracting achievements for indefinite-delivery, indefinite-quantity contracts with individual subcontracting plans where the contract is intended for use by multiple agencies;
(iv) Submit the Individual Subcontract Report (ISR) and/or the Summary Subcontract Report (SSR), in accordance with paragraph (l) of FAR 52.219-9 using the Electronic Subcontracting Reporting System (eSRS) at http://www.esrs.gov. The reports shall provide information on subcontract awards to small business concerns (including ANCs and Indian tribes that are not small businesses), veteran-owned small business concerns, service-disabled veteran-owned small business concerns, HUBZone small business concerns, small disadvantaged business concerns (including ANCs and Indian tribes that have not been certified by SBA as small disadvantaged businesses), women-owned small business concerns, and for NASA only, Historically Black Colleges and Universities and Minority Institutions. Reporting shall be in accordance with 52.219-9, or as provided in agency regulations;
| Reporting Period |
| Report Due |
| Due Date |
| Oct 1 - Mar 31 |
| ISR |
| 30-Apr |
| Apr 1 - Sept 30 |
| ISR |
| 30-Oct |
| Oct 1 - Sept 30 |
| SSR |
| 30-Oct |
| Oct 1 – Sep 30 |
| Year End SDB Report |
| 90 days of SSR submission |
| Contract Completion |
| Final ISR |
| 30 days after completion |
Please refer to FAR Part 19.7 for instructions regarding the submission of a Commercial Plan: SSR are due on 10/30 each year for the previous fiscal year ending 9/30. Reports are required when due, regardless of whether there has been any subcontracting activity since the inception of the contract or the previous reporting period.
(v) Ensure that its subcontractors with subcontracting plans agree to submit the ISR and/or the SSR using eSRS;
(vi) Provide its prime contract number, its unique identity identifier, and the e-mail address of the Offeror’s official responsible for acknowledging receipt of or rejecting the ISRs, to all first-tier subcontractors with subcontracting plans so they can enter this information into the eSRS when submitting their ISRs; and
(vii) Require that each subcontractor with a subcontracting plan provide the prime contract number, its own unique identity identifier, and the e-mail address of the subcontractor’s official responsible for acknowledging receipt of or rejecting the ISRs, to its subcontractors with subcontracting plans.
Note: The eSRS system does not allow firms to submit a separate report for each Task Order issued. Therefore, eSRS reporting for USCG IDIQ contracts must include information pertaining to each Task Order issued under the IDIQ contract. Contractors MUST include a statement in the remarks section of eSRS that references the Task Order number, dollars awarded, and subcontracting plan percentage that is applicable to each Task Order contract.
11. Description of Record Types (See FAR 19.704(a)(11))
The following is a description of the types of records that will be maintained concerning procedures that have been adopted to comply with the requirements and goals in the plan, including establishing source lists; and a description of the offeror’s efforts to locate small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns and award subcontracts to them.
The records shall include at least the following (on a plant-wide or company-wide basis, unless otherwise indicated):
(i) Source lists (e.g., SAM), guides, and other data that identify small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns.
(ii) Organizations contacted in an attempt to locate sources that are small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, or women-owned small business concerns.
(iii) Records on each subcontract solicitation resulting in an award of more than the simplified acquisition threshold, as defined in FAR 2.101 on the date of subcontract award, indicating—
(A) Whether small business concerns were solicited and, if not, why not;
(B) Whether veteran-owned small business concerns were solicited and, if not, why not;
(C) Whether service-disabled veteran-owned small business concerns were solicited and, if not, why not;
(D) Whether HUBZone small business concerns were solicited and, if not, why not;
(E) Whether small disadvantaged business concerns were solicited and, if not, why not;
(F) Whether women-owned small business concerns were solicited and, if not, why not; and
(G) If applicable, the reason award was not made to a small business concern.
(iv) Records of any outreach efforts to contact—
(A) Trade associations;
(B) Business development organizations;
(C) Conferences and trade fairs to locate small, HUBZone small, small disadvantaged, service-disabled veteran-owned, and women-owned small business sources; and
(D) Veterans service organizations.
(v) Records of internal guidance and encouragement provided to buyers through–
(A) Workshops, seminars, training, etc.; and
(B) Monitoring performance to evaluate compliance with the program’s requirements.
(vi) On a contract-by-contract basis, records to support award data submitted by the offeror to the Government, including the name, address, and business size of each subcontractor. Contractors having commercial plans need not comply with this requirement.
12. Description of Good Faith Effort (See FAR 19.704(a)(12))
Maximum practicable utilization of SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns, as subcontractors, in Government contracts is a matter of national interest with both social and economic benefits. When a contractor fails to make a good faith effort to comply with a subcontracting plan, these objectives are not achieved and 15 U.S.C. 637(d) (4) (F) directs that liquidated damages SHALL be paid by the contractor. Describe the company’s commitment to make a good faith effort to ensure that the subcontracting goals are met.
<Insert Vendor Name> will make a good faith effort to acquire articles, equipment, supplies, services, or materials, or obtain the performance of construction work from the small business concerns that the offeror used in preparing the bid or proposal, in the same or greater scope, amount, and quality used in preparing and submitting the bid or proposal. Responding to a request for a quote does not constitute use in preparing a bid or proposal. An offeror used a small business concern in preparing the bid or proposal if –
i. The offeror identifies the small business concern as a subcontractor in the bid or proposal or associated small business subcontracting plan, to furnish certain supplies or perform a portion of the contract; or
ii. The offeror used the small business concern’s pricing or cost information or technical expertise in preparing the bid or proposal, where there is written evidence of an intent or understanding that the small business concern will be awarded a subcontract for the related work if the offeror is awarded the contract.
13. Additional Assurances
a. <Insert Vendor Name> will provide the contracting officer with a written explanation if the contractor fails to acquire articles, equipment, supplies, services or materials or obtain the performance of construction work as described in paragraph 12 of this plan. This written explanation will be submitted to the contracting officer within 30 days of contract completion. (See FAR 19.704(a)(13))
b. <Insert Vendor Name> will not prohibit a subcontractor from discussing with the contracting officer any material matter pertaining to payment to or utilization of a subcontractor. (See FAR 19.704(a)(14))
c. <Insert Vendor Name> will pay its small business subcontractors on time and in accordance with the terms and conditions of the subcontract, and notify the contracting officer if the offeror pays a reduced or an untimely payment to a small business subcontractor (see 52.242-5). (See FAR 19.704(a)(15)) If this is a direct award, the contractor is required to provide the names, contact information, and socio-economic status of the firms slated to receive a contract. Identifying firms after award is not conducive to meeting the goals required by the plan. If this is an Indefinite Delivery-Indefinite Quantity (IDIQ) contract, the contractor is required to provide the names, contact information, and socio-economic status of the firms slated to receive a contract at the time a task order is issued FAR 19.705-1(b).
Required Signatures:
This subcontracting plan was submitted by:
Signature: __________________________________________________
Typed/Print Name: __________________________________________________
Title: __________________________________________________
Date: __________________________________________________
As covered by FAR 19.702(c) and referenced by 15 U.S.C. 637(d)(8), any contractor or subcontractor failing to comply in good faith with the requirements of the subcontracting plan is in material breach of its contract. Further, 15 U.S.C. 637(d)(4)(F) directs that a contractor’s failure to make a good faith effort to comply with the requirements of the subcontracting plan shall result in the imposition of liquidated damages.
This plan was reviewed and approved by:
Signature: __________________________________________________
Typed/Print Name: __________________________________________________
Title: Contracting Officer
Date: __________________________________________________
Bureau, Office, Mission Name: ___________________________________________
Contract Number Associated with the Plan: _________________________________
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