Attachment_I.pdf

ATTACHMENT I

PROPOSED SUBCONTRACTING PARTICIPATION BREAKDOWN

(TO BE SUBMITTED BY SMALL BUSINESSES)

(CONTRACTOR’S NAME)

(ADDRESS)

Solicitation or Contract Number

(Title of the Project)

(Location)

(Date Prepared)

SUBCONTRACTING BREAKDOWN – (Base Year and/or All Bid Items excluding Options)

1. Estimated $ value of all planned subcontracting $________________

2. Estimated $ value of all work to be performed by offeror’s workforce $________________

3. Total $ value of the proposal (sum of 1 and 2) $________________

4. Subcontracts for products and services to be awarded under this project.

a. Large Business: (LB)

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

b. Small Business (SB)

(1) SMALL DISADVANTAGED BUSINESSES: (SDB)

(2) WOMEN-OWNED SMALL BUSINESSES: (WOSB)

TOTAL: $_______________

(3) HISTORICALLY UNDERUTILIZED BUSINESS ZONE (HUBZone) BUSINESS:

(4) VETERAN OWNED SMALL BUSINESS: (VOSB)

(5) SERVICE-DISABLED VETERAN OWNED SMALL BUSINESS: (SDVOSB)

(6) HISTORICALLY BLACK COLLEGES AND UNIVERSITIES & MINORITY INSTITUTIONS:

(HBCU/MI)

NAME OF C, U, OR MI TYPE OF SERVICES $ VALUE OF SUBCONTRACT

(7) ABILITYONE PROGRAM (FORMERLY JWOD) - NISH

NOTES:

1. The sum of lines 4.a and 4.b must equal line 1.

2. Lines 4.b. (1) through 4.b (7) identify various categories of small businesses under the main small business (SB) group. Subcontracts to companies that qualify in multiple categories must be reported under each category. For example: if you are planning to subcontract $100,000 to ABC, a woman-owned small disadvantaged business that is also a certified HUBZone small business, you will report $100,000 on line 4.b SB, line 4.b

(1) SDB, line 4.b (2) WOSB and line 4.b.(3) HUBZone SB.

Line Item Base Option 1 Option 2 TOTAL

DOLLARS

Total dollar value of this contract.

Total Subcontracted

Large Business $ $ $ $ Small Business $ $ $ $

SDB $ $ $ $

WOSB $ $ $ $

HUBZone SB $ $ $ $

VOSB $ $ $ $

SDVOSB

HBCU/MI $ $ $ $

ABILITYONE -

NISH

PERCENTAGES

*Large Business % % % % *Small Business % % % %

*SDB % % % %

*WOSB % % % %

*HUBZone SB % % % %

*VOSB % % % %

*SDVOSB

*HBCU/MI % % % %

*ABILITYONE-

NISH

*% of total dollars subcontracted