Attachment_G.pdf

ATTACHMENT G

SMALL BUSINESS PAST PERFORMANCE

Small Business offerors, newly established Large Business offerors, or Large Business Offerors with no prior SF294/ISR history shall complete this form. Large Business Offerors with a SF294 or ISR history shall submit SF294s or ISRs in lieu of completing this form.

(a) SUBCONTRACTING ACHIEVEMENT – Include actual dollar values subcontracted for each of the categories listed. Include the percentage goal only if a goal was established.

(1) Contract Number/Title:

ACTUAL GOAL

(if applicable) Completion Date: Total Contract Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent

(a) Small Business Concerns (Including SDB, WOSB, HBCU/MI, HUBZone, VOSB, and

SDVOSB) (Dollar amount and percent of line c.)

Small Business Concerns (Non-Federal Certifications Examples:

MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise), DVBE (Disabled Veteran Business Enterprise), SB (Small Business), WBE (Women’s Business Enterprise).

(b) Large Business Concerns (Dollar amount and percent of line c.)

(c) Total (sum of lines a & b above)

(d) Small Disadvantaged Business Concerns (Dollar amount and percent of line c.)

Including MBE & DBE

(e) Women-Owned Small Business Concerns (Dollar amount and percent of line c.)

Including WBE

(f) HUBZone Small Business Concerns (Dollar amount and percent of line c.)

(g) Veteran-Owned Small Business Concerns (Dollar amount and percent of line c.)

(h) Service Disabled Veteran-Owned Small Business Concerns (Dollar amount and percent of line c.)

Including DVBE

Name of customer reference for this project: ___________________________________________ Phone Number: _______________________ FAX Number: _______________________ Email address: ________________________________________

(2) Contract Number/Title:

ACTUAL GOAL

(if applicable) Completion Date: Contract Dollar Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent

(b) Small Business Concerns (Including SDB, WOSB, HBCU/MI, HUBZone, VOSB, and

SDVOSB) (Dollar amount and percent of line c.)

Small Business Concerns (Non-Federal Certifications Examples:

MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise),

(h) Service Disabled Veteran-Owned Small Business Concerns (Dollar

(3) Contract Number/Title:

ACTUAL GOAL

(if applicable) Completion Date: Contract Dollar Value: $ Total Subcontracted Value: $ Whole Dollars Percent Percent

(c) Small Business Concerns (Including SDB, WOSB, HBCU/MI, HUBZone, VOSB, and

SDVOSB) (Dollar amount and percent of line c.)

Small Business Concerns (Non-Federal Certifications Examples:

MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise),

(h) Service Disabled Veteran-Owned Small Business Concerns (Dollar

Note: Form may be expanded.