Attachment 5 -SBPCD.pdf

RFP #N00173-23-R-GD01

Attachment 5

Small Business Participation Commitment Document (SBPCD) Template

1. Prime Contractor Size:

Indicate the applicable size and socioeconomic categories -- all that apply:

{ } Other than Small Business or { } Small Business also categorized as a

{ } Small Disadvantaged Business (SDB) { } Woman-Owned Small Business (WOSB) { } Historically Underutilized Business Zone (HUBZone) Small Business { } Service Disabled Veteran Owned Small Business (SDVOSB)

2. Participation of Small Businesses

Total Contract Value (Proposed)

Minimum Quantitative Requirement (MQR)

Business Category Dollar Value % of Total Contract Value

Total Contract Value – Prime Contractor $ % Total work to be self-performed $ % Other than Small Business (OTS) $ Dollar Value Total Small Business $ %

Small Disadvantaged Business $ % Woman-Owned Small Business $ % HUBZone Small Business $ %

Veteran-Owned Small Business $ % Service-Disabled Veteran-Owned Small

Business

3. Indicate any work to be self-performed and the total value associated

Type of Product/Service $ Dollar Value % of Total Contract Value

RFP #N00173-22-R-6000

Attachment 5

4. List all Other than Small Business Participants (OTS)

Company Name

Product(s)/Service(s) to be Provided

NAICS

Code

Nature of Commitment

$ Dollar Value % of Total Contract Value

5. Small Business Participants

Company Name

Product(s)/Service(s) to be Provided

NAICS

Code

Nature of Commitment

$ Dollar Value % of Total Contract Value

SIGNATURE REQUIRED: Must be signed and dated by a company official to be valid

This Small Business Participation Commitment Plan was SUBMITTED by:

Signature:

Typed Name:

Title:

Company Name:

Date Signed:

Contracting Officer APPROVAL:

Typed Name:

Title:

Small Business Professional APPROVAL:

Typed Name:

Title: