5_DD2579.pdf

SMALL BUSINESS COORDINATION RECORD

REPORT CONTROL SYMBOL

DD-AT&L(AR)1862

1. CONTROL NO. (Optional) 2. PURCHASE REQUEST NO./

REQUISITION NO.

3. TOTAL ESTIMATED VALUE

(Including options)

4. SOLICITATION NO./CONTRACT

MODIFICATION NO.

5. BUYER

a. NAME (Last, First, Middle Initial) b. OFFICE SYMBOL c. TELEPHONE (Include Area Code)

6. ITEM DESCRIPTION (Including quantity) 6a. FEDERAL SUPPLY CLASS/SERVICE

(FSC/SVC) CODE

7. TYPE OF COORDINATION (X one) 8. SMALL BUSINESS SIZE STANDARD

INITIAL CONTACT

MODIFICATION WITHDRAWAL

a. NORTH AMERICAN INDUSTRY CLASSIFICATION

SYSTEM (NAICS) CODE

b. NO. OF EMPLOYEES c. DOLLARS

9. RECOMMENDATION (X as applicable) 10. ACQUISITION HISTORY (X one) YES NO (If all recommendations are "No," explain in Remarks.)

a. SECTION 8(a) (X one)

(1) COMPETITIVE (2) SOLE SOURCE

b. SMALL DISADVANTAGED BUSINESS (SDB) SET-ASIDE

c. HISTORICALLY BLACK COLLEGES AND UNIVERSITIES/

MINORITY INSTITUTIONS (HBCU/MI) SET-ASIDE

(List percentage)

d. SMALL BUSINESS (SB) SET-ASIDE (List percentage)

e. EMERGING SMALL BUSINESS SET-ASIDE

f. EVALUATION PREFERENCE FOR SDBs

g. HUBZONE SET-ASIDE

h. HUBZONE SOLE SOURCE

i. HUBZONE PRICE EVALUATION PREFERENCE

a. FIRST TIME BUY

b. PREVIOUS ACQUISITION (X all that apply)

(1) SECTION 8(a)

(2) SDB SET-ASIDE

(3) HBCU/MI SET-ASIDE

(4) SB SET-ASIDE

(5) OTHER (Specify)

(6) TWO OR MORE RESPONSIVE SB OFFERS ON PRIOR ACQUISITION

11. SB PROGRESS PAYMENTS

(X one)

YES NO

12. SUBCONTRACTING PLAN

REQUIRED (X one)

YES NO

13. SYNOPSIS REQUIRED (X one) (If "No," cite FAR 5.202 exception)

YES NO

14. REMARKS

16. LOCAL USE15. REVIEWED BY SMALL BUSINESS ADMINISTRATION (SBA)

REPRESENTATIVE

a. NAME (Last, First, Middle Initial)

b. SIGNATURE c. DATE SIGNED

(YYYYMMDD)

17. CONTRACTING OFFICER (X one)

CONCURS REJECTS

18. SMALL BUSINESS SPECIALIST (X one)

CONCURS APPEALS

a. RECOMMENDATIONS (Document rejections on reverse side)

c. SIGNATURE d. DATE SIGNED

(YYYYMMDD)

b. NAME (Last, First, Middle Initial)

NOTE: Any change in the acquisition plan this coordination record describes will require return for re-evaluation by the SB specialist.

b. SIGNATURE c. DATE SIGNED

(YYYYMMDD)

a. NAME (Last, First, Middle Initial)

DD FORM 2579, DEC 2000

(7) ONE OR MORE RESPONSIVE SDB OFFER(S) WITHIN 10% OF

AWARD PRICE OF PRIOR ACQUISITION

PREVIOUS EDITION IS OBSOLETE. Adobe Professional X

(8) WOMAN OWNED SB

(9) SERVICE-DISABLED VETERAN SB