ATTACHMENT - SMALL BUSINESS SUBCONTRACTING RECORD.pdf
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- Solicitation number
- N4008023R0007
About this file
This document is an attachment containing a small business subcontracting record form. The form collects data on five federal contracts, including contract numbers and titles, prime or subcontract status, completion dates, total contract values, total subcontracted values, and percentages and dollar amounts subcontracted to various small business categories. It also requests references for each contract.
The related federal contract opportunity is solicitation number N4008023R0007 for construction services including a vehicle control center, commercial vehicle inspection building, inspection canopy, sentry booth, parking lot, and incidental work at a value of over $2 million. The solicitation is for the Department of the Navy Naval Facilities Engineering Command to construct these facilities at a military base for vehicle inspection and visitor control.
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ATTACHMENT D
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
(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:
SUBCONTRACT
GOAL
(if applicable) Completion Date: Contract Dollar Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent
(b) 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.)
(3) Contract Number/Title:
SUBCONTRACT
GOAL
(if applicable) Completion Date: Contract Dollar Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent
(c) 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), (4)Contract Number/Title:
SUBCONTRACT
GOAL
(if applicable) Completion Date: Total Contract Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent
(d) 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) Other Than Small (OTS) Business Concerns (Dollar amount and percent of
(5) Contract Number/Title:
SUBCONTRACT
GOAL
(if applicable) Completion Date: Contract Dollar Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent
(e) 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),
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