Attachment 23 Small Business Participation Commitment.pdf

This form is not to be edited or modified. Please do not add notation(s) to the form. The form is to be used as it is presented in the solicitation. For every small business listed on this form you must submit a signed binding agreement with the SBC (i.e., letter of commitment, joint ventures, mentor protégé agreements, others). Binding commitments shall become enforceable, contractual requirements.

Small Business Participation Commitment Document (SBPCD)

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. Minimum Quantitative Requirement (MQR) -- Participation of Small Businesses*

*Small Business Participation, reporting applies

Total Contract Value Including all options (Awarded) $

Minimum Quantitative Requirement (MQR)

Business Category Dollar Value % of Total Contract Value

Total Contract Value – Prime Contractor $ % Total Small Business $ %

Small Disadvantaged Business $ % Woman-Owned Small Business $ % HUBZone Small Business $ % Veteran-Owned Small Business $ % Service-Disabled Veteran-Owned Small Business $ %

Total: $ %

This form is not to be edited or modified. Please do not add notation(s) to the form. The form is to be used as it is presented in the solicitation. For every small business listed on this form you must submit a signed binding agreement with the SBC (i.e., letter of commitment, joint ventures, mentor protégé agreements, others). Binding commitments shall become enforceable, contractual requirements.

3. Small Business Participants *

* Changes to this form must be pre-approved by Contracting Officer

Company Name

Cage Code/DUNS #

Business Category(ies)

(SB, WOSB,

SDB, VOSB,

SDVOSB)

Product(s)/Service(s) to be Provided (List task(s) as prescribed in the PWS)

NAICS

Code

Nature of Commitment (i.e., letter of commitment, joint ventures, mentor protégé agreements, others