J.P-5_A3 Small Business Engagement_Template.pdf

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Attached to
Alliant 3 GWAC 2nd Draft Request for Proposal (RFP), Request for Information (RFI)
Solicitation number
47QTCK22N003
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This template provides guidance for prime contractors to report on small business subcontractors' experience with emerging technologies under the Alliant 3 GWAC. It requests information on the contractor, small business, NAICS code, engagement date, references, total value, and a 1500 character description of the small business's project experience. The related federal contract opportunity is the Alliant 3 GWAC 2nd draft RFP and RFI from GSA to provide broad scope IT services to government agencies on an indefinite delivery/indefinite quantity basis. It does not specify required products or services.

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Alliant 3 GWAC Solicitation No.:

J.P-5 Small Business Emerging Technology Engagement Template

ATTACHMENT J.P-5

SMALL BUSINESS EMERGING TECHNOLOGY ENGAGEMENT TEMPLATE

PART I: PROJECT IDENTIFICATION

OFFEROR CONTRACTOR NAME:

OFFEROR CONTRACTOR UEI:

SMALL BUSINESS CONTRACTOR NAME:

SMALL BUSINESS CONTRACTOR UEI:

CONTRACTOR IS A SMALL BUSINESS UNDER NAICS 541512?

ENGAGEMENT DATE

EMERGING TECHNOLOGY DEMONSTRATED

PART II: PROJECT REFERENCE INFORMATION

Cognizant Project Official (For Federal or Commercial Projects)

NAME:

TITLE:

SMALL BUSINESS CONTRACTOR NAME:

PHONE:

E-MAIL:

CUSTOMER NAME:

TOTAL PERIOD OF PERFORMANCE, INCLUDING OPTIONS: (MM/YYYY -

MM/YYYY or MM/YYYY – Present)

TOTAL PROJECT VALUE:

Alliant 3 GWAC Solicitation No.:

J.P-5 Small Business Emerging Technology Engagement Template

PART III: PROJECT DESCRIPTION

Narrative statement clearly explaining the small business detailed experience on this project. Limit response to 1500 characters.

PART IV: SMALL BUSINESS CONTRACTOR ATTESTATION

From the Prime Contractor Representative identified in Part II

This signature hereby attests that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.

NAME:

DATE:

SIGNATURE:

OFFEROR CONTRACTOR NAME:
OFFEROR CONTRACTOR UEI:
SMALL BUSINESS CONTRACTOR NAME:
SMALL BUSINESS CONTRACTOR UEI:
CONTRACTOR IS A SMALL BUSINESS UNDER NAICS 541512:
ENGAGEMENT DATE:
NAME:
TITLE:
SMALL BUSINESS CONTRACTOR NAME:
PHONE:
EMAIL:
CUSTOMER NAME:
TOTAL PERIOD OF PERFORMANCE INCLUDING OPTIONS MMYYYY MMYYYY or MMYYYY Present:
TOTAL PROJECT VALUE:
NAME DATE:
Small Business Emerging Technology Project Description:
Dropdown3: [Choose 1]

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