ATTACHMENT 3 - Historical SB Utilization Form.docx
DOCX document 38 KB Posted
- Attached to
- SEAWALL REPAIRS FOR FARRAGUT AND SANTEE BASIN, UNITED STATES NAVAL ACADEMY, ANNAPOLIS, MD
- Solicitation number
- N4008022R3927
About this file
This document is an attachment providing a template for offerors to submit their historical small business utilization on federal contracts. It requires offerors to provide details on up to five past projects, including contract numbers, total values, small business subcontracting amounts and percentages to small businesses, small disadvantaged businesses, women-owned small businesses, HUBZone small businesses, veteran-owned small businesses, and service-disabled veteran-owned small businesses. Offerors must provide explanations for any unmet small business subcontracting goals and lack of small business achievements. For each project, offerors also submit a customer reference contact. This attachment will be used by agencies to evaluate offerors' past performance in meeting small business participation requirements for the related federal contract opportunity to repair seawalls at the United States Naval Academy in Annapolis, Maryland.
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ATTACHMENT 3
HISTORICAL SMALL BUSINESS UTILIZATION
This form is to be completed by all Offerors (both large and small businesses) in order to provide supporting information for the evaluation of Factor 6, Small Business Utilization and Participation. Attachment 6 documents the offeror’s historical small business utilization and achievements for each project submitted under Factor 2, Experience. Round all percentages to the nearest tenth of a percent (i.e., include only 1 number after the decimal point).
Include actual dollar values subcontracted for each of the categories listed. Include the whole dollar and percentage goals ONLY if a goal was established. If established goals were not met on any submitted projects, an explanation for each unmet goal is required. Acknowledging a goal was missed, is not the same as providing an explanation for why a goal was missed. If goals were not established for a project, mark N/A. Enter zeroes (0) where applicable.
Project #1: Contract/Project Number/Task Order Number:
Project Title:
Offeror Size: Large Business |_| Small Business |_|
Performed as: Prime Contractor |_| Subcontractor |_| JV Member |_|
Subcontracting Plan Required: |_| Yes |_| No
| ACTUAL |
| GOAL |
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Whole Dollars |
| Percent of line (c) |
| N/A |
Total Self Performed Value: $
Total Subcontracted Value: $
| (a) Small Business Concerns (Include Values from d-h below and Self-Performed Value IF Small Business) |
| $ |
| % |
| $ |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| $ |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns (SDB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns (WOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns (VOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns (SDVOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
Explanation of each unmet goal (if applicable):
Explanation for a lack of small business subcontracting achievements (if applicable):
Name of customer reference for this project:
Phone Number:
Email address:
Project #2: Contract/Project Number/Task Order Number:
Project Title:
Offeror Size: Large Business |_| Small Business |_|
Performed as: Prime Contractor |_| Subcontractor |_| JV Member |_|
Subcontracting Plan Required: |_| Yes |_| No
| ACTUAL |
| GOAL |
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Whole Dollars |
| Percent of line (c) |
| N/A |
Total Self Performed Value: $
Total Subcontracted Value: $
| (a) Small Business Concerns (Include Values from d-h below and Self-Performed Value IF Small Business) |
| $ |
| % |
| $ |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| $ |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns (SDB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns (WOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns (VOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns (SDVOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
Explanation of each unmet goal (if applicable):
Name of customer reference for this project:
Email address:
Project #3: Contract/Project Number/Task Order Number:
Project Title:
Offeror Size: Large Business |_| Small Business |_|
Performed as: Prime Contractor |_| Subcontractor |_| JV Member |_|
Subcontracting Plan Required: |_| Yes |_| No
| ACTUAL |
| GOAL |
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Whole Dollars |
| Percent of line (c) |
| N/A |
Total Self Performed Value: $
Total Subcontracted Value: $
| (a) Small Business Concerns (Include Values from d-h below and Self-Performed Value IF Small Business) |
| $ |
| % |
| $ |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| $ |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns (SDB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns (WOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns (VOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns (SDVOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
Explanation of each unmet goal (if applicable):
Name of customer reference for this project:
Email address:
Project #4: Contract/Project Number/Task Order Number:
Project Title:
Offeror Size: Large Business |_| Small Business |_|
Performed as: Prime Contractor |_| Subcontractor |_| JV Member |_|
Subcontracting Plan Required: |_| Yes |_| No
| ACTUAL |
| GOAL |
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Whole Dollars |
| Percent of line (c) |
| N/A |
Total Self Performed Value: $
Total Subcontracted Value: $
| (a) Small Business Concerns (Include Values from d-h below and Self-Performed Value IF Small Business) |
| $ |
| % |
| $ |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| $ |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns (SDB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns (WOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns (VOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns (SDVOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
Explanation of each unmet goal (if applicable):
Name of customer reference for this project:
Email address:
Project #5: Contract/Project Number/Task Order Number:
Project Title:
Offeror Size: Large Business |_| Small Business |_|
Performed as: Prime Contractor |_| Subcontractor |_| JV Member |_|
Subcontracting Plan Required: |_| Yes |_| No
| ACTUAL |
| GOAL |
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Whole Dollars |
| Percent of line (c) |
| N/A |
Total Self Performed Value: $
Total Subcontracted Value: $
| (a) Small Business Concerns (Include Values from d-h below and Self-Performed Value IF Small Business) |
| $ |
| % |
| $ |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| $ |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns (SDB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns (WOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| $ |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns (VOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns (SDVOSB) |
| $ |
| % |
| $ |
| % |
| |_| |
Explanation of each unmet goal (if applicable):
Name of customer reference for this project:
Email address:
Attachment X – Historical Small Business Utilization, Page 4 of 4
(Rev 3/2020)
File details come from the government source that posted it. Updated .