Attachment 4 SB Participation Commitment Document.pdf

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 (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: $ %

3. Small Business Participants *

* Changes 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

NAICS

Code

Nature of Commitment