J.16 Performance in Utilizing Small Business (SB) Concerns Template.pdf

ATTACHMENT J.16 – PERFORMANCE IN USING SMALL BUSINESS (SB)

CONCERNS

1. Small Business Utilization Summary

1. Prime Contractor Name:

2. Prime Contractor Address:

3. Summary of Small Business Utilization (see Section L.7.c.6.n for the required information in this summary):

2. Submitted eSRS on Recent Contracts

Provide a list of the recent contracts, within the past three (3) years, for which the offeror submitted subcontract reports to eSRS (FAR 52.219-9(d)(10) and a copy of any similarly recent subcontracting reports if they were not submitted to eSRS. Repeat the tables below as needed.

Contract Information

Name of Awarding Entity:

Contract/Award Number:

Contract/Award Type:

Contract/Award Period of Performance:

Contract/Award Value (TEC/TEA): (if subcontract/subaward, subcontract/subaward value):

Contracting/Agreement/Awarding Officer (name, phone and email):

Contracting Officer’s Representative (COR)/Agreement Officer’s Representative (AOR)/Project Manager (name, phone and email):

Contract Information

Name of Awarding Entity:

Contract/Award Number:

Contract/Award Type:

Contract/Award Period of Performance:

Contract/Award Value (TEC/TEA): (if subcontract/subaward, subcontract/subaward value):

Contracting/Agreement/Awarding Officer (name, phone and email):

Contracting Officer’s Representative (COR)/Agreement Officer’s Representative (AOR)/Project Manager (name, phone and email):

Contract Information

Name of Awarding Entity:

Contract/Award Number:

Contract/Award Type:

Contract/Award Period of Performance:

Contract/Award Value (TEC/TEA): (if subcontract/subaward, subcontract/subaward value):

Contracting/Agreement/Awarding Officer (name, phone and email):

Contracting Officer’s Representative (COR)/Agreement Officer’s Representative (AOR)/Project Manager (name, phone and email):

3. Subcontract References

Provide the names and addresses of three (3) SB concerns for USAID to contact for their assessment of the organization’s performance in using SB concerns.

Subcontract Reference 1 Subcontractor Name and Address:

Subcontractor Contact Person (name, title, phone and email):

Subcontract amount:

Subcontract Period of Performance:

Description of Work:

Subcontract Reference 2 Subcontractor Name and Address:

Subcontractor Contact Person (name, title, phone and email):

Subcontract amount:

Subcontract Period of Performance:

Description of Work:

Subcontract Reference 3 Subcontractor Name and Address:

Subcontractor Contact Person (name, title, phone and email):

Subcontract amount:

Subcontract Period of Performance:

Description of Work: