J-6 Small Business Participation Commitment Document.docx

DOCX document 28 KB Posted

Attached to
Space Science Instruments and Experimental Payloads (SSIEP) Federal contract opportunity
Solicitation number
N00173-22-R-SD01
Issued by
Department of the Navy Secretary of the Navy Office of Naval Research

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Text version

Small Business Participation Commitment Document (SBPCD) Template

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. Participation of Small Businesses

Total Contract Value (Proposed)$

Minimum Quantitative Requirement (MQR)

Business Category
Dollar Value
% of Total Contract Value
Total Contract Value – Prime Contractor
$
%
Total work to be self-performed
$
%
Other than Small Business (OTS)
$
Dollar Value
Total Small Business
$
%
Small Disadvantaged Business
$
%
Woman-Owned Small Business
$
%
HUBZone Small Business
$
%
Veteran-Owned Small Business
$
%
Service-Disabled Veteran-Owned Small Business
$
%

3. Indicate any work to be self-performed and the total value associated

Type of Product/Service
$ Dollar Value
% of Total Contract Value
$
%
$
%
$
%
$
%

RFP #N00173-22-R-SD01

Attachment J-6

4. List all Other than Small Business Participants (OTS)

Company Name
Product(s)/Service(s) to be Provided
NAICS

Code

Nature of Commitment
$ Dollar Value
% of Total Contract Value
$
%
$
%
$
%
$
%

5. Small Business Participants

Company Name
Product(s)/Service(s) to be Provided
NAICS

Code

Nature of Commitment
$ Dollar Value
% of Total Contract Value
$
%
$
%
$
%
$
%

SIGNATURE REQUIRED: Must be signed and dated by a company official to be valid

This Small Business Participation Commitment Plan was SUBMITTED by:

Signature:

Typed Name:

Title:

Company Name:

Date Signed:

Contracting Officer APPROVAL:

Signature:

Typed Name:

Title:

Date Signed:

Small Business Professional APPROVAL:

Signature:

Typed Name:

Title:

Date Signed:

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