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EXHIBIT “E”
PAST PERFORMANCE – SMALL BUSINESS UTILIZATION
N62473-22-R-1201
This form is to be completed by all Offerors (both large and small businesses) in order to provide supporting information for evaluation of Factor 2, Past Performance. 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 percentage goal only if a goal was established. If established goals were not met on any submitted projects, an explanation for each unmet goal is required. If goals were not established for a project, mark N/A.
Items (a) – (h) are for SUBCONTRACTED values only. Small Business Offerors shall not include self-performed work under these items.
| Business Size: |
| |_| Large |
| |_| Small |
| |_| Small Disadvantaged |
| |_| Women-Owned Small Business |
| |_| HUBZone Small Business |
| |_| Veteran-Owned Small Business |
| |_| Service-Disabled Veteran-Owned Small Business |
| |_| Other: |
Project #1: Contract/Project Number/Task Order Number:
Project Title:
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Percent of line (c) |
| N/A |
Total Subcontracted Value: $
| (a) Small Business Concerns (Including SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB, and HBCU/MI) |
| $ |
| % |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns |
| $ |
| % |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
Detailed explanation of each unmet goal and the corrective actions taken (if applicable):
Name of customer reference for this project:
Phone Number:
Email address:
Project #2: Contract/Project Number/Task Order Number:
Project Title:
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Percent of line (c) |
| N/A |
Total Subcontracted Value: $
| (a) Small Business Concerns (Including SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB, and HBCU/MI) |
| $ |
| % |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns |
| $ |
| % |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
(h) Service-Disabled Veteran-Owned Small Business Concerns
Detailed explanation of each unmet goal and the corrective actions taken (if applicable):
Name of customer reference for this project:
Phone Number:
Email address:
Project #3: Contract/Project Number/Task Order Number:
Project Title:
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Percent of line (c) |
| N/A |
Total Subcontracted Value: $
| (a) Small Business Concerns (Including SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB, and HBCU/MI) |
| $ |
| % |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns |
| $ |
| % |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
Detailed explanation of each unmet goal and the corrective actions taken (if applicable):
Name of customer reference for this project:
Phone Number:
Email address:
Project #4: Contract/Project Number/Task Order Number:
Project Title:
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Percent of line (c) |
| N/A |
Total Subcontracted Value: $
| (a) Small Business Concerns (Including SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB, and HBCU/MI) |
| $ |
| % |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns |
| $ |
| % |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
Detailed explanation of each unmet goal and the corrective actions taken (if applicable):
Name of customer reference for this project:
Phone Number:
Email address:
Project #5: Contract/Project Number/Task Order Number:
Project Title:
(if applicable)
| Total Project Dollar Value: $ |
| Whole Dollars |
| Percent of line (c) |
| Percent of line (c) |
| N/A |
Total Subcontracted Value: $
| (a) Small Business Concerns (Including SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB, and HBCU/MI) |
| $ |
| % |
| % |
| |_| |
| (b) Large Business Concerns |
| $ |
| % |
| % |
| |_| |
| (c) Total (sum of lines a & b above) |
| $ |
| % |
| % |
| |_| |
| (d) Small Disadvantaged Business Concerns |
| $ |
| % |
| % |
| |_| |
| (e) Women-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (f) HUBZone Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (g) Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
| (h) Service-Disabled Veteran-Owned Small Business Concerns |
| $ |
| % |
| % |
| |_| |
Detailed explanation of each unmet goal and the corrective actions taken (if applicable):
Name of customer reference for this project:
Phone Number:
Email address:
