Attachment_4.A_-_Small_Business_Subcontracting_Record.docx
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- Attached to
- N62470-17-R-4010 Professional Services to support NAVFAC Public Works Business Line in NAVFAC AOR
- Solicitation number
- N6247017R4010
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Attachment_4.A_-_Small_Business_Subcontracting_Record.docx
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ATTACHMENT 4.A
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 line c.)
| (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: | ||||
| Check One: | Prime Contract | Subcontract Subcontracting Plan Required | Yes | No |
| ACTUAL SUBCONTRACTED |
| SUBCONTRACT GOAL |
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.)
(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 line c.)
| (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:
| (3) Contract Number/Title: | ||||
| Check One: | Prime Contract | Subcontract Subcontracting Plan Required | Yes | No |
| ACTUAL SUBCONTRACTED |
| SUBCONTRACT GOAL |
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.)
(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 line c.)
(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:
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