_RFP_Attachment_F_SB_Offeror_SB_Participation_Breakdown_.docx

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NAS Jacksonville Airfield and Lighting Repairs
Solicitation number
N69450-14-R-1261
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ATTACHMENT F

PROPOSED SUBCONTRACTING PARTICIPATION BREAKDOWN

(TO BE SUBMITTED BY SMALL BUSINESSES)

(CONTRACTOR’S NAME)

(ADDRESS)

N69450-14-R-1261

NAS Jacksonville Airfield and Lighting Repairs Naval Air Station Jacksonville FL

(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)

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

(1) SMALL DISADVANTAGED BUSINESSES: (SDB)

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

(2) WOMEN-OWNED SMALL BUSINESSES: (WOSB)

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $_______________

(3) HISTORICALLY UNDERUTILIZED BUSINESS ZONE (HUBZone) BUSINESS:

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

(4) VETERAN OWNED SMALL BUSINESS: (VOSB)

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

(5) SERVICE-DISABLED VETERAN OWNED SMALL BUSINESS: (SDVOSB)

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

(6) HISTORICALLY BLACK COLLEGES AND UNIVERSITIES & MINORITY INSTITUTIONS: (HBCU/MI)

NAME OF C, U, OR MI TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

(7) ABILITYONE PROGRAM (FORMERLY JWOD) - NISH

NAME OF COMPANY TYPE OF SERVICES $ VALUE OF SUBCONTRACT

TOTAL: $________________

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 61

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

Line Item

Base

Option 1

Option 2

TOTAL

DOLLARS

Total dollar value of this contract.

Total Subcontracted

Large Business

Small Business

SDB

WOSB

HUBZone SB

VOSB

SDVOSB

HBCU/MI

ABILITYONE -NISH

PERCENTAGES

*Large Business

*Small Business

*SDB

*WOSB

*HUBZone SB

*VOSB

*SDVOSB

*HBCU/MI

*ABILITYONE-NISH

*% of total dollars subcontracted

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