JM-4.pdf

ATTACHMENT JM-4

PROPOSED SUBCONTRACTING PARTICIPATION BREAKDOWN

(TO BE SUBMITTED BY SMALL BUSINESSES)

(CONTRACTOR’S NAME)

(ADDRESS)

Solicitation N62470-14-R-5001

Service Life Extension Program (SLEP) for 60 Ton Portal Cranes

Norfolk Naval Shipyard, Portsmouth, VA (NNSY), Puget Sound Naval Shipyard & Intermediate Maintenance Facility, Bremerton, WA (PSNSY, IMF) and

Portsmouth Naval Shipyard, Kittery, ME (PNSY)

(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)

Revised 7 December 2011 1

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

(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) – SOURCEAMERICA (FORMERLY NISH)

Revised 7 December 2011 2

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.

Revised 7 December 2011 3

Line Item Base Option 1 Option 2 Option 3

DOLLARS

Total dollar value of this contract.

Total Subcontracted

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

SDB $ $ $ $

WOSB $ $ $ $

HUBZone SB $ $ $ $

VOSB $ $ $ $

SDVOSB $ $ $ $

HBCU/MI $ $ $ $

ABILITYONE -

SOURCEAME

RICA

PERCENTAGES

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

*SDB % % % %

*WOSB % % % %

*HUBZone SB % % % %

*VOSB % % % %

*SDVOSB % % % %

*HBCU/MI % % % %

*ABILITYONE-

*% of total dollars subcontracted

Revised 7 December 2011 4

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

Line Item Option 4 TOTAL

DOLLARS

Total dollar value of this contract.

Total Subcontracted

Large Business $ $ Small Business $ $

SDB $ $

WOSB $ $

HUBZone SB $ $

VOSB $ $

SDVOSB $ $

HBCU/MI $ $

ABILITYONE -

RICA $ $

PERCENTAGES

*Large Business % % *Small Business % %

*SDB % %

*WOSB % %

*HUBZone SB % %

*VOSB % %

*SDVOSB % %

*HBCU/MI % %

*ABILITYONE-

*% of total dollars subcontracted

Revised 7 December 2011 5