Attachment_5-N00173-17-R-DH02_SBPCD_Template.pdf

NOTE: TEMPLATES MUST BE TAILORED TO ACQUISITION-SPECIFIC

REQUIREMENTS AS STATED IN THE SOLICITATION

Small Business Participation Plan 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 (Awarded) $__________________________________

Planned SB Participation Values *

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

3. Small Business Participants

Company Name

Business Category(ies)

(SB, WOSB, SDB,

VOSB, SDVOSB)

Product(s)/Service(s) to be Provided

NAICS

Code

Nature of Commitment

* Small Business Offerors should remember to include thier own effort(s) when addressing the names, products/services and estimated dollars planned to be provided in the appropriate Business Category(ies)

(i.e., letter of commitment, joint ventures, mentor protégé, others)