Attachment J_Self-Perform Cert and Notification of Subcontracting.doc

N44255-21-R-2001_Attachment J

PRE-AWARD CONTRACTOR’S SELF-PERFORMANCE CERTIFICATION

AND NOTIFICATION OF SUBCONTRACTING

From: Company Name, Street Address, City, State, Zip

To:

Name of Contracting Officer, FEAD/Office Name, Naval Facilities Engineering Systems Command, XXXXXX Subj:

Contract No. NXXXXX-XX-X-XXXX

1. In accordance with the provisions of (select appropriate clause from selection below), Small Business Concerns

FAR 52.219-6, Notice of Total Small Business Set Aside (DEVIATION 2019-O0003)

FAR 52.219-7, Notice of Partial Small Business Set-Aside (DEVIATION 2019-O0003)

FAR 52.219-14, Limitations on Subcontracting (DEIVIATION 2019-O0003)

8(a) Program Participants

FAR 52.219-14, Limitations on Subcontracting (DEVIATION 2019-O0003)

DFARS 252.219-7010, Notification of Competition Limited to Eligible 8(a) Concerns-Partnership Agreement (DEVIATION 2019-O0003)

HUBZone Small Business Concerns

FAR 52.219-3, Notice of HUBZone Set-Aside or Sole Source Award (DEVIATION 2019-O0003)

FAR 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (DEVIATION 2019-O0003)

SDVOSB Concerns

FAR 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (DEVIATION 2019-O0003)

EDWOSB Concerns

FAR 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business Concerns (DEVIATION 2019-O0003)

WOSB Concerns Eligible under the WOSB Program

FAR 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (DEVIATION 2019-O0003) the Contracting Officer is hereby notified that Company intends to subcontract the following portion(s) of the requirements of this contract:

NAME:

ADDRESS:

CAGE/DUNS:

PRIMARY NAICS:

COMPANY SIZE:

POC:

PHONE:

EMAIL:

NAME:

ADDRESS:

CAGE/DUNS:

PRIMARY NAICS:

COMPANY SIZE:

POC:

PHONE:

EMAIL:

* * Table may be expanded as needed.

2. Furthermore, in accordance with the provision cited above, by submission of an offer and execution of this contract, Company agrees that in performance of this contract, in the case of a contract for –

(a) Services (except construction) - At least 50% of the cost of contract performance incurred for personnel shall be expended for employees of the concern.

(b) Supplies (other than procurement from non-manufacturer of such supplies) - The concern shall perform work for at least 50% of the cost of manufacturing the supplies, not including the cost of materials.

(c) General construction - The concern will perform at least 15% of the cost of the contract, not including the cost of materials, with its own employees.

(d) Construction by special trade contractors - The concern will perform at least 25% of the cost of the contract, not including the cost of materials, with its own employees.

3. Additionally, Company certifies that they will self-perform the following work –

* * Table may be expanded as needed.

Note: Dollar value of subcontracted work plus self-performed work should equal total award.

4. No changes in subcontractors are allowed without prior written approval of the Contracting Officer. The contractor shall notify the Contracting Officer a minimum of 10 business days prior to any needed change. The contractor shall not proceed with any requested change in advance of written approval from the Contracting Officer.

CONTRACTOR:

SIGNATURE

NAME AND TITLE

DATE

CONTRACTING OFFICER APPROVAL:

POST-AWARD CONTRACTOR’S LIMITATIONS

ON SUBCONTRACTING CERTIFICATION

From:

Contractor Name, Street Address, City, State, Zip

To:

Name of Contracting Officer, FEAD/Office Name, Naval Facilities Engineering

Command, XXXXX

Subj:

Contract No. NXXXXX-XX-X-XXXX

1. Prime contractor is to complete and submit the following for each reporting period (6 months) for each performance period (Base Year and Options). The reporting periods are 01 October – 31 March and 01 April - 30 September annually. The contractor shall submit the report to the Contracting Officer within 30 calendar days of the end of each reporting period.

Block 1

Period of Performance

Block 2

FFP &

Task Order #

(list TO#) Block 3

Prime

Labor Cost Block 4

Subcontractor

Labor Cost Block 5

Total FFP or Task Order

Labor Cost Block 6

% Cost

Performed by

Prime Block 7

% Cost

Performed by Subcontractor

Base Period

(Insert reporting period dates)

FFP

TO # 0001

TO # 0002

** add rows here

TOTAL FOR REPORTING PERIOD

Base Period

(Insert reporting period dates)

TO XXXX

TO XXXX

Etc.

** add rows here

TOTAL FOR REPORTING PERIOD

TOTAL PERFORMANCE PERIOD (Base Year)

2. Furthermore, in accordance with the following provisions of (select appropriate clause identified below based on type of contract), in the performance of this contract, Small Business Concerns

FAR 52.219-6, Notice of Total Small Business Set Aside (DEVIATION 2019-O0003)

FAR 52.219-7, Notice of Partial Small Business Set-Aside (DEVIATION 2019-O0003)

FAR 52.219-14, Limitations on Subcontracting (DEIVIATION 2019-O0003)

8(a) Program Participants

FAR 52.219-14, Limitations on Subcontracting (DEVIATION 2019-O0003)

DFARS 252.219-7010, Notification of Competition Limited to Eligible 8(a) Concerns-Partnership Agreement (DEVIATION 2019-O0003)

HUBZone Small Business Concerns

FAR 52.219-3, Notice of HUBZone Set-Aside or Sole Source Award (DEVIATION 2019-O0003)

FAR 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (DEVIATION 2019-O0003)

SDVOSB Concerns

FAR 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (DEVIATION 2019-O0003)

EDWOSB Concerns

FAR 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business Concerns (DEVIATION 2019-O0003)

WOSB Concerns Eligible under the WOSB Program

FAR 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (DEVIATION 2019-O0003)

FORMCHECKBOX

In the case of a contract for services (except construction), your Company Name has performed at least 50 percent of the cost of the contract incurred for personnel with its own employees.

In the case of a contract for supplies or products (other than procurement from a non-manufacturer in such supplies or products your Company Name has performed at least 50 percent of the cost of manufacturing the supplies or products (not including the costs of materials).

In the case of a contract for general construction, your Company Name has performed at least 15 percent of the cost of the contract with its own employees (not including the costs of materials).

In the case of a contract for construction by special trade contractors, your Company Name has performed at least 25 percent of the cost of the contract with its own employees (not including the cost of materials).

I certify that to the best of its knowledge and belief, the information provided in this report is accurate, complete, and current as of the date of report.

CONTRACTOR:

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