Attachment 0042 - Certification for Subcontractors Not Registered in SAM.docx
DOCX document 28 KB Posted
- Attached to
- DRAFT Request for Proposal Project Management Mounted Armored Vehicle Logistic Fielding Support Services
- Solicitation number
- W912CH-25-R-0182
- Issued by
-
Department of the Army
About this file
This is a certification form template for subcontractors that are not registered in the System for Award Management (SAM). The form is designed for prime offerors to distribute to proposed small business subcontractors who lack SAM registration, requiring them to self-certify their small business status and socioeconomic designations. The prime offeror must first populate the solicitation number, applicable NAICS code, and corresponding size standard (measured in either employee count or average annual receipts) before sending the form to the subcontractor.
The subcontractor completing the form must certify their eligibility status by checking all applicable categories: Small Business (SB), Small Disadvantaged Business (SDB), Woman Owned Small Business (WOSB), Veteran Owned Small Business (VOSB), or Service Disabled Veteran Owned Small Business (SDVOSB), as defined in FAR 2.101 and 13 CFR 121.103. The form explicitly notes that contractors cannot self-certify as 8(a) Small Disadvantaged Businesses or HUBZone Small Businesses, as these designations require formal SBA certification and SAM registration. The completed form must be signed and dated by an official authorized to represent the company. This template is applicable to the W912CH-25-R-0182 solicitation for PM MAV Logistic Fielding Support Services issued by the Department of the Army.
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Text version
Certification of Small Business Size and Socioeconomic Status For Proposed Subcontractors Not Registered in the System for Award Management (SAM) Instructions for Prime Offeror:
1. Obtain this certification from any small business listed in the proposal that is not registered in SAM at https://www.sam.gov.
2. Before sending to a subcontractor to fill in, insert the Solicitation Number, NAICS code associated with the work to be done by the subcontractor, and the size standard for that NAICS code. Insertion of subcontract number or other internal tracking code is optional.
Instructions for Subcontractor:
1. Do not fill in this form if the NAICS code or one of the size standard fields has not been filled in by the prime offeror.
2. Fill in the other fields below. {The fields will expand as you type.}
3. Provide Name, Title, and Signature of official authorized to sign for the company and the date.
Solicitation Number: W56HZV-{ }-{ }-{ } Subcontract Number or Other Internal Tracking Code (Optional): { }
| Company Name: | { } | |
| Address: | { } |
I hereby certify that for the North American Industry Classification System (NAICS) code of { } defined in https://www.census.gov/eos/www/naics/ with a size standard of { } employees / $ { } average annual receipts assigned at https://www.sba.gov/contracting/getting-started-contractor/make-sure-you-meet-sba-size-standards, the above named business is a (check all that apply):
|_| Small Business (SB) |_| Small Disadvantaged Business (SDB) |_| Woman Owned Small Business (WOSB) |_| Veteran Owned Small Business (VOSB) |_| Service Disabled Veteran Owned Small Business (SDVOSB) as defined in Federal Acquisition Regulation (FAR) 2.101, FAR Clause 52.219-8, and taking into consideration the 13 CFR 121.103 “How does SBA determine affiliation” at http://www.ecfr.gov.
The contractor may self-certify in the above categories. A Contractor cannot self-certify as an 8(a) Small Disadvantaged Business or a Historically Underutilized Small Business Zone Small Business (HUBZone SB). These require certification by the Small Business Administration (SBA) and registration in the System for Award Management (SAM) and the SBA’s Dynamic Small Business Search Database.
Official authorized to sign for the company
| Name: | { } |
| Title: | { } |
Electronic Signature: { } or Handwritten Signature: _______________________________________________________________
| Electronic Date: | { } |
| or Handwritten Date: | ___________________ |
Form version: 18 Nov 2016 - Distribution Statement A – Approved for Public Release
File details come from the government source that posted it. Updated .