Attachment F - Small Business Subcontracting Record.docx
DOCX document 18 KB Posted
- Solicitation number
- N4008520R0063
About this file
This document is a small business subcontracting record template to be completed by contractors bidding on the Design-Bid-Build, P653 Dry Dock Flood Protection Improvements solicitation from the Department of the Navy Naval Facilities Engineering Command. The template requires contractors to provide details of past subcontracting achievements, including dollar values and percentages awarded to various small business categories such as small disadvantaged businesses, women-owned small businesses, HUBZone small businesses, veteran-owned small businesses, and service-disabled veteran-owned small businesses. Contractors must provide this subcontracting record for at least their three most recent and relevant contracts. The solicitation seeks to construct a permanent flood wall to protect four dry docks, associated facilities and infrastructure from flooding from the Elizabeth River. The flood wall will be a cast-in-place reinforced concrete wall on a shallow foundation supported by soil treated with subsurface grout injection. Modifications will also be made to existing dry dock structures and new removable capstans will be constructed.
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Text version
| DBB, P653 Dry Dock Flood Protection Improvements | N40085-20-R-0063 | |
| Norfolk Naval Shipyard, Portsmouth, VA | Source Selection Plan |
ATTACHMENT F
SMALL BUSINESS SUBCONTRACTING RECORD
COMPANY NAME: _______________________________________
SUBCONTRACTING ACHIEVEMENTS – Include actual dollar values subcontracted for each of the categories listed. Include the percentage goal only if a goal was established. Note: Form may be expanded.
(1) Contract Number/Title:
Check One: ____ Prime Contract ____ Subcontract
Subcontracting Plan Required ____ Yes ____ No
ACTUAL
SUBCONTRACTED
SUBCONTRACT GOAL
(if applicable)
Completion Date: Total Contract Value: $
| Total Subcontracted Value: $ |
| Whole Dollars |
| Percent |
| Percent |
(a) Small Business Concerns (Including SDB, WOSB, HUBZone, VOSB, SDVOSB and AbilityOne entities) (Dollar amount and percent of line c.)
Small Business Concerns (Non-Federal Certifications Examples:
MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise), DVBE (Disabled Veteran Business Enterprise), SB (Small Business), WBE (Women’s Business Enterprise).
(b) Other Than Small (OTS) Business Concerns (Dollar amount and percent of line c.)
(c) Total (sum of lines a & b above)
(d) Small Disadvantaged Business Concerns (Dollar amount and percent of line c.) Including MBE & DBE
(e) Women-Owned Small Business Concerns (Dollar amount and percent of line c.) Including WBE
(f) HUBZone Small Business Concerns (Dollar amount and percent of line c.)
(g) Veteran-Owned Small Business Concerns (Dollar amount and percent of line c.)
(h) Service Disabled Veteran-Owned Small Business Concerns (Dollar amount and percent of line c.) Including DVBE
Name of customer reference for this project: ___________________________________________ Phone Number: _______________________ FAX Number: _______________________ Email address: ________________________________________
(2) Contract Number/Title:
ACTUAL
SUBCONTRACT GOAL
Completion Date: Contract Dollar Value: $
| Total Subcontracted Value: $ |
| Whole Dollars |
| Percent |
| Percent |
(a) Small Business Concerns (Including SDB, WOSB, HUBZone, VOSB, SDVOSB and AbilityOne entities) (Dollar amount and percent of line c.)
Small Business Concerns (Non-Federal Certifications Examples:
MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise),
(b) OTS Business Concerns (Dollar amount and percent of line c.)
(c) Total (sum of lines a & b above)
(d) Small Disadvantaged Business Concerns (Dollar amount and percent of line c.) Including MBE & DBE
(e) Women-Owned Small Business Concerns (Dollar amount and percent of line c.) Including WBE
(f) HUBZone Small Business Concerns (Dollar amount and percent of line c.)
(g) Veteran-Owned Small Business Concerns (Dollar amount and percent of line c.)
(h) Service Disabled Veteran-Owned Small Business Concerns (Dollar
(3) Contract Number/Title:
ACTUAL
SUBCONTRACT GOAL
Completion Date: Contract Dollar Value: $
| Total Subcontracted Value: $ |
| Whole Dollars |
| Percent |
| Percent |
(a) Small Business Concerns (Including SDB, WOSB, HUBZone, VOSB, SDVOSB and AbilityOne entities) (Dollar amount and percent of line c.)
Small Business Concerns (Non-Federal Certifications Examples:
MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise),
(b) OTS Business Concerns (Dollar amount and percent of line c.)
(c) Total (sum of lines a & b above)
(d) Small Disadvantaged Business Concerns (Dollar amount and percent of line c.) Including MBE & DBE
(e) Women-Owned Small Business Concerns (Dollar amount and percent of line c.) Including WBE
(f) HUBZone Small Business Concerns (Dollar amount and percent of line c.)
(g) Veteran-Owned Small Business Concerns (Dollar amount and percent of line c.)
(h) Service Disabled Veteran-Owned Small Business Concerns (Dollar
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