DD2579.pdf

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Continuation Sheet Purchase Request Number:

Page of Pages of

Designer 11

4a. PIID e TELEPHONE NUMBER (Include Area Code

c. OFFICE SYMBOL

d. E-MAIL ADDRESS

3. TOTAL ESTIMATED VALUE

(With options)

2. PURCHASE REQUEST/

REQUISITION NO.

b. IDV PIID (If applicable)

5. MOD/AMDMT NO.

6a. CONTRACTING OFFICER NAME

(Last, First, Middle Initial)

b. DODAAC

10. RECOMMENDATION

(X all that apply)

8. PERIOD OF PERFORMANCE/DELIVERY DATES

(Including options)

a. SMALL BUSINESS SET-ASIDE (X one) 100% Partial

HISTORICALLY UNDERUTILIZED BUSINESS ZONE

Competitive

ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS (EDWOSB) SET_ASIDE

(Complete block 13

OTHER SET-ASIDE

(Cite authority, e.g., FAR 26.202-1 or 6.208; or DFARS 226.71

i. FULL AND OPEN COMPETITION

HUBZONE PRICE EVALUATION PREFERENCE

b. SECTION 8(a)

(X one)

Competitive

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB)

(X one)

11a. MARKET RESEARCH/ACQUISITION PLAN

DD FORM 2579, AUG 2015

MULTIPLE AWARD

PREVIOUS EDITION IS OBSOLETE.

WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER WOSB PROGRAM SET-ASIDE

Sole Source

Reserves

(FAR 19.5)

(List type(s) of small business, e.g., WOSB, SDVOSB)

7a. ITEM AND/OR SERVICE DESCRIPTION

1. CONTROL NO.

(Optional)

b. PRODUCT OR SERVICE CODE

C. NAICS CODE

d. SIZE STANDARD

9. PURPOSE OF COORDINATION

(X One)

Initial Coordination Withdrawal Change

(HUBZone) SMALL BUSINESS

Sole Source (Ref. FAR 19.1307) j.

Competitive Sole Source

OTHER THAN FULL AND OPEN COMPETITION NOT PREVIOUSLY ADDRESSED

Contract Delivery/Task Order

13. SUBCONTRACTING PLAN REQUIRED

(X one)

b. SYNOPSIS REQUIRED

c. SMALL BUSINESS PROGRESS PAYMENTS (NOTE: Synopsis not required if <$25,000; see FAR 5.101 (a) (1).)

12. CONSOLIDATED OR BUNDLED

(X one) (X one) (X as applicable)

a. CONSOLIDATED REQUIREMENT

b. BUNDLED REQUIREMENT (Attach required ocumentation per DFARS 207.170.)

(Attach required documentation per FAR 7.107 including benefit analysis.)

(Provide FAR 5.202 exception) Yes No Yes Yes Yes Yes No No No No

(See DFARS PGI 253.219-70 for form completion instructions.)

c.

e.

g.

d.

f.

h.

See Attached Page(s)

SMALL BUSINESS COORDINATION RECORD

14. ACQUISTION HISTORY

a. IS THIS A NEW REQUIREMENT?

(X one) Yes No

b. PREVIOUSLY CONSOLIDATED OR BUNDLED?

c. DETAILS OF PREVIOUS AWARD(S)

15. CONTRACTING OFFICER

a. NAME

c. SIGNATURE

16. SMALL BUSINESS PROFESSIONAL/SMALL BUSINESS DIRECTOR REVIEW

DD FORM 2579, AUG 2015

PREVIOUS EDITION IS OBSOLETE.

Designer 11

c. SIGNATURE

f. SMALL BUSINESS PROFESSIONAL/SMALL BUSINESS DIRECTOR REMARKS

17. SBA PROCUREMENT CENTER REPRESENTATIVE REVIEW

c. SIGNATURE

e. SBA PROCUREMENT CENTER REPRESENTATIVE REMARKS

18. CONTRACTING OFFICER REVIEW

c. CONTRACTING OFFICER REMARKS (Continue to Blocks a (1) through (10), making all apply for the immediately preceding acquisition.)

(Proceed to Block 15)

(1) SMALL BUSINESS SET-ASIDE

(3)

(5)

(7)

HISTORICALLY UNDERUTILIZED BUSINESS ZONE (HUBZone) SMALL BUSINESS

ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS (EDWOSB) SET-ASIDE

OTHER SET-ASIDE

(Cite authority, e.g., FAR 26.202-1 or 6.208; or DFARS 226.71)

(9) FULL AND OPEN COMPETITION

(Complete block 13) (X one)

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB)

(4)

(6)

WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER WOSB PROGRAM SET-ASIDE

(8)

OTHER THAN FULL AND OPEN COMPETITION NOT PREVIOUSLY ADDRESSED

(10) MULTIPLE AWARD

Contract Delivery/Task Order (X one)

(2) SECTION 8(a) (X one)

Competitive

Competitive

Competitive Sole Source Sole Source Sole Source 100% Partial

HUBZONE PRICE EVALUATION PREFERENCE

(REF. FAR 19.1307)

Reserves

(FAR 19.5)

(List type(s) of small business, e.g., WOSB, SDVOSB)

(1) CONSOLIDATED

(X one) Yes No

(2) BUNDLED

Yes No (List details requested in instructions. Attach additional page(s) if necessary.)

b. E-MAIL ADDRESS

d. DATE SIGNED

(YYYYMMDD)

b. E-MAIL ADDRESS

Concur

Non-concur e.DATE ACQUISTION PACKAGE PROVIDED TO SBA (FAR 19.202-1(e)) (YYYYMMDD)

Concur with PCR recommendation

Reject PCR recommendation

a. SIGNATURE

b. DATE SIGNED

Concur

Non-concur

b. E-MAIL ADDRESS

(YYYYMMDD)

Additional Remarks

Solicitation No./ Contract Modification No.

Total Estimated Value (Including options)

PR: PR Total Price:

Item

NSN

AMSC

Description Quantity Unit Price

Information Used in Set-Aside Determination:

Offers Expected

NSN

CAGE

Vendor Name Business Size Source of Record Reference Number

Manufacturing Sources

NSN

CAGE

Part Number Business Size Source of Business Size Source of Record

Qualified Sources

NSN

Qualification Type

CAGE

Company Name

Procurement History

CAGE

Source Type Contract Number Quantity Unit Cost Award Date Price Reason CD Term CD

Legend Business Size/Source Type Description 1.5 Microsoft® Office Word 2007 Microsoft® Office Word 2007 D:20091021232346 D:20091021232346 Microsoft® Office Word 2007