ATTACHMENT D SB SUB RECORD.pdf
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- Solicitation number
- N4008519R9257
About this file
This document is a small business subcontracting record template for tracking subcontracting achievements on federal contracts. It requires contractors to provide actual dollar values subcontracted to various small business categories on up to three past contracts, including small disadvantaged businesses, women-owned small businesses, HUBZone small businesses, veteran-owned small businesses, and service-disabled veteran-owned small businesses. Contractors must also provide reference contact information for each contract. No specific products, services, response dates, or award information is included, as this appears to be a generic template rather than a solicitation.
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Text version
ATTACHMENT D
SMALL BUSINESS SUBCONTRACTING RECORD
COMPANY NAME: _______________________________________
SUBCONTRACTING ACHIEVEMENTS – Include actual dollar values subcontracted for each of the categories listed. Include the percentage goal only if a goal was established. Note: Form may be expanded.
(1) Contract Number/Title:
Check One: ____ Prime Contract ____ Subcontract
Subcontracting Plan Required ____ Yes ____ No
ACTUAL
SUBCONTRACTED
SUBCONTRACT
GOAL
(if applicable)
Completion Date: Total Contract Value: $
Total Subcontracted Value: $ Whole Dollars Percent Percent
(a) Small Business Concerns (Including SDB, WOSB, HUBZone, VOSB, SDVOSB and AbilityOne entities) (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) Other Than Small (OTS) 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
(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:
SUBCONTRACT
GOAL
(if applicable)
Completion Date: Contract Dollar Value: $
Total Subcontracted Value: $ Whole Dollars Percent Percent
(b) Small Business Concerns (Including SDB, WOSB, HUBZone, VOSB, SDVOSB and AbilityOne entities) (Dollar amount and percent of line c.)
Small Business Concerns (Non-Federal Certifications Examples:
MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise),
(b) OTS Business Concerns (Dollar amount and percent of line c.)
(3) Contract Number/Title:
SUBCONTRACT
GOAL
(if applicable)
Completion Date: Contract Dollar Value: $
Total Subcontracted Value: $ Whole Dollars Percent Percent
(c) Small Business Concerns (Including SDB, WOSB, HUBZone, VOSB, SDVOSB and AbilityOne entities) (Dollar amount and percent of line c.)
Small Business Concerns (Non-Federal Certifications Examples:
MBE (Minority Business Enterprise), DBE (Disadvantaged Business Enterprise),
(b) OTS Business Concerns (Dollar amount and percent of line c.)
File details come from the government source that posted it. Updated .