_ATTACHMENT_1_Proposal_forms.doc

ATTACHMENT C

INDIVIDUAL SMALL BUSINESS SUBCONTRACTING PLAN

NAVFAC Southeast sub-contracting goals are as follows:

Small Business – 45%

HUBZone –3%

Small Disadvantaged Business – 5%

Women-Owned Small Business – 15%

Service-Disabled Veteran Owned Small Business – 5%

ATTACHMENT C

INDIVIDUAL SMALL BUSINESS SUBCONTRACTING PLAN (Template) Edit or delete red font text and complete fill-ins as applicable

This template is designed to be consistent with FAR 19.704, Subcontracting Plan Requirements and FAR clause 52.219-9, Small Business Subcontracting Plan (“subcontracting plan”). Other formats may be acceptable, including commercial or master subcontracting plans; however, failure to include the essential information exemplified in this individual plan template may be cause for delay in acceptance or rejection of a bid/offer.

(TO BE SUBMITTED BY OTHER THAN SMALL BUSINESSES ONLY)

(Also referred to as large businesses)

(CONTRACTOR’S NAME)

(ADDRESS)

(CONTRACTOR’S CORPORATE HEADQUARTERS ADDRESS)

[If same as above, so indicate].

(Solicitation or Contract Number)

(Title of the Project and Location)

(Date Prepared)

PLAN SUBMITTED BY:

Signature: __________________________________ Date: ____________________

Printed Name: ___________________________________________________________

Title: __________________________________________________________________

REVIEWED:

Small Business Professional

Date

REVIEWED:

Small Business Administration

Procurement Center Representative

ACCEPTED:

Procuring Contracting Officer

SUBCONTRACTING PLAN

This document, together with any attachments, is submitted as a subcontracting plan to satisfy the requirements of Federal Acquisition Regulations (FAR) 19.704. The following goals are established for the contract (including base period and all option items/periods (if applicable)). Attachment 1 provides breakdowns for the base year and option periods. Percentages may be rounded to nearest tenth of a percent. INCLUDE SUPPORTING RATIONALE FOR ALL PROPOSED GOALS AND ENSURE THIS PLAN IS CONSISTENT WITH ANY SMALL BUSINESS PARTCIPATION AND COMMITMENT STRATEGY ASSOCIATED WITH THIS ACQUISITION.

1.

a. Total Contract Value

(including options)

b. Total Subcontracted

_______% of 1.a

(inclusive of all planned subcontracting to all businesses, regardless of size)

c. Total Prime-performed

_______% of 1.a

2. The following dollars and percentage goals are applicable to the contract cited above. (See FAR 19.704(a)(1) and (2))

a. Large Business

_______% of 1.b

This number represents total planned subcontract dollars that will be awarded to other than small business concerns (including subcontracts awarded to Historically Black Colleges, Universities and Minority Institutions (HBCU/MIs).

b. Small Business (SB)

_______% of 1.b

This number represents total planned subcontract dollars that will be awarded to small business concerns** as well as subcontracts awarded under the AbilityOne Program to SourceAmerica (formerly NISH) and National Industries for the Blind (NIB) organizations and subcontracts awarded to Alaskan Native Corporations (ANCs) and Indian Tribes as prescribed in FAR 19.703(c) & FAR 52.219-9.

(** Small business concerns include SBs, Small Disadvantaged Businesses (SDB), Women-Owned Small Businesses (WOSB), Historically Underutilized Business Zone (HUBZone) small businesses, Veteran-Owned Small Businesses (VOSB) and Service-Disabled Veteran-Owned Small Businesses (SDVOSB))

(Include 2.c, 2.d, 2.e, 2.f, 2.g, 2.h, and 2.i, below).

Notes:

(1) Lines 1.b + 1.c=100% of Line 1.a

(2) Lines 2.a + 2.b = 100% of Line 1.b

(3) Lines 2.c, 2.d, 2.e, 2.f, 2.g, 2.h, and 2.i are calculated against Line 1.b, the total value of overall subcontract dollars.

(4) Subcontracts to companies that qualify in multiple categories of SB must be reported under each category. For example: if you are planning to subcontract $100,000 to company ABC, a woman-owned SDB that is also a certified HUBZone SB, you will report $100,000 on line 2.b (SB), 2.c (HUBZone), 2.d (WOSB) and 2.e (SDB). Accordingly, the sum of 2.c through 2.i will not necessarily equate to the value of 2.b.

(5) Designated HUBZone SBs must be certified by the Small Business Administration (SBA).

c. HUBZone SB ________% of 1.b

This number represents total planned subcontract dollars that will be awarded to qualified HUBZone small business concerns certified by SBA. (Included in total for 2.b, above)

d. WOSB $_______________ ________% of 1.b

This number represents total planned subcontract dollars under that will be awarded to WOSBs. (Included in total for 2.b, above)

e. SDB

This number represents total planned subcontracting dollars that will be awarded to small business concerns owned and controlled by socially and economically disadvantaged individuals (include in this category the planned subcontracting dollars to ANCs and Indian Tribes shown in total for 2.i below). (Included in total for 2.b, above)

f. VOSB

This number represents total planned subcontract dollars that will be awarded to small business concerns owned and controlled by veterans (include in this category the planned subcontracting dollars for SDVOSBs shown in 2.g below). (Included in total for 2.b, above)

g. SDVOSB

This number represents total planned subcontract dollars under this contract that will be awarded to subcontractors who are small business concerns owned and controlled by service-disabled veterans. (Included in totals for 2.b and 2.f, above)

h. AbilityOne

________% of l.b.

This number represents total planned subcontract dollars that will be awarded to AbilityOne associated nonprofit agencies through SourceAmerica and NIB. Per DFARS 219.703, subcontracts awarded to qualified non-profit agencies for the blind or severely disabled may be counted toward the small business subcontracting goal. (Included in total for 2.b, above)

i. Alaskan Native

Corporations &

Indian Tribes

________% of l.b.

This number represents total planned subcontract dollars that will be awarded to ANCs and Indian Tribes and for which the prime contractor has been designated to receive SDB credit. (See FAR 19.703 & FAR 52.219-9) (Included in totals for 2.b and 2.e, above)

3. The following principal products and/or services will be subcontracted under this contract. (See FAR 19.704(a)(3)

a. Products/services planned to be subcontracted to LB concerns (including HBCU/MIs):

Firm subcontract commitments :

Name of Company/DUNS

Products or Services b.

Products/services planned to be subcontracted to SB concerns:

Firm subcontract commitments:

c.

Products/services planned to be subcontracted to certified HUBZone concerns:

d.

Products/services planned to be subcontracted to WOSB concerns:

e.

Products/services planned to be subcontracted to SDB concerns:

f.

Products/services planned to be subcontracted to VOSB concerns:

g.

Products/services planned to be subcontracted to SDVOSB concerns:

h. Products/services planned to be subcontracted to AbilityOne organizations:

Name of Organization/DUNS

i. Planned products/services to be subcontracted to ANCs and Indian Tribe businesses (See 2.i above for explanation):

4.

The following methods were used to develop the above subcontracting goals. Include a statement explaining how the products and services to be subcontracted were established, how the products and services to be subcontracted to SB, SDB, WOSB, HUBZone, VOSB, SDVOSB concerns, AbilityOne program participants, ANCs and Indian Tribes were determined, and how their capabilities were assessed. (See FAR 19.704(a)(4))

5.

The following methods were/will be used to identify potential sources for solicitation purposes: (See FAR 19.704(a)(5)) The offeror may rely on the information contained in SAM as an accurate representation of a concern’s size and ownership characteristics for the purposes of maintaining a SB, VOSB, SDVOSB, HUBZone, SDB, and WOSB source list. Use of SAM as a source list does not relieve the offeror of its responsibilities (e.g., outreach, assistance, counseling, or publicizing subcontracting opportuniuties.

6.

Indirect and overhead costs ( have ( have not been included in the goals specified in 1. and 2. above. If "have" is checked, explain the method used in determining the proportionate share of indirect costs to be incurred with SBs (including all subcategories delineated above). (See FAR 19.704(a)(6))

7.

The following employee will administer the subcontracting program: (See FAR 19.704(a)(7))

NAME:

ADDRESS:

TELEPHONE NO.:

FAX NO.: ___________________________

EMAIL: ____________________________________________________________________

TITLE: _____________________________________________________________________

This individual has general overall responsibility for the company's small business program. This person should have knowledge of the federal small business programs and be knowledgeable about federal procurement practices. If the prime decides to change the person in this position, they must notify the Contracting Officer and the Deputy for Small Business. The administrator is responsible for the development, preparation and execution of this subcontracting plan, and for monitoring performance relative to contractual subcontracting requirements contained in this plan, including:

a. Developing and maintaining bidders lists of SB, SDB, WOSB, HUBZone SB, VOSB, SDVOSB concerns, AbilityOne program participants, HBCU/MIs, ANCs, and Indian Tribes (hereafter referred to as the small business community) from all possible sources.

b. Counsel and discuss subcontracting opportunities with representatives of the small business community.

Ensuring that procurement packages are structured to permit the small business community to participate to the maximum extent possible.

Assuring inclusion of the small business community in all solicitations for products or services, which they are capable of providing.

Reviewing solicitations to remove statements, clauses, etc., which may tend to restrict or prohibit the small business community participation.

f. Assign each subcontract the NAICS code and corresponding size standard that best describes the principal purpose of the subcontract.

g. Confirm that a subcontractor representing itself as a HUBZone small business concern is certified by SBA as a HUBZone small business concern by SBA in accordance with 52.219-8(d)(2)

h. Provide notice to subcontractors concerning penalties and remedies for misrepresentations of business status as small, veteran-owned small business, HUBZone small, small disadvantaged, or women-owned small business for the purpose of obtaining a subcontract that is to be included as part or all of a goal contained in the subcontracting plan.

i.

Ensuring periodic rotation of potential subcontractors on bidders lists.

j.

Ensuring that the bid proposal review board documents its reasons for not selecting low bids submitted by the small business community.

k.

Ensuring the establishment and maintenance of records of solicitations and subcontract award activity.

l.

Attending or arranging for attendance of company counselors at Business Opportunity Workshops, Minority Business Enterprise Seminars, Trade Fairs, etc.

m.

Conducting or arranging for the motivational training for purchasing personnel pursuant to the intent of P.L. 95-507.

n.

Monitoring attainment of proposed goals.

o.

Preparing and submitting required periodic subcontracting reports.

p.

Coordinating contractor's activities during the conducting of compliance reviews by Federal agencies.

q.

Coordinating the conduct of contractor's activities involving its small business subcontracting program.

r.

Additional duties.

8.

The following efforts will be taken to ensure that the small business community will have an equitable opportunity to compete for subcontracts. (See FAR 19.704(a)(8)) a.

Outreach efforts will be made by identifying:

- Contacts with minority and small business trade associations.

- Contacts with business development organizations.

- Attendance at small and minority business procurement conference and trade fairs.

b.

Sources will be requested from the System for Award Management (SAM) website available at https://www.sam.gov/ on the Internet.

Automated data base sources to be used, other than SAM, will be as follows.

The following internal efforts will be made to guide and encourage buyers:

(i) Workshops, seminars and training programs will be conducted.

(ii) Activities will be monitored to evaluate compliance with this subcontracting plan.

(iii) Arrange interviews with the small business community.

Describe how your small business database, source lists, guides, and other data will be maintained and utilized by buyers in soliciting subcontracts; e.g., rotation of firms in the data base, keeping data base current and useful.

9.

Provide assurances the offeror agrees that the FAR clause 52.219-8 entitled "Utilization of Small Business Concerns " will be included in all subcontracts which offer further subcontracting opportunities, and all subcontractors, except SB concerns, that receive subcontracts in excess of $700,000 ($1,500,000 for construction) will be required to adopt plans that comply with the requirements of the clause at 52.219-9, Small Business Subcontracting Plan. Such plans will be reviewed by comparing them with the provisions of P.L. 95-507 and assuring that all minimum requirements of an acceptable subcontracting plan have been satisfied. The acceptability of percentage goals shall be determined on a case-by-case basis depending on the supplies/services involved, the availability of potential small and small disadvantaged subcontractors, and prior experience. Once approved and implemented, plans will be monitored through the submission of periodic reports, and/or, as time and availability of funds permit, periodic visits to review subcontracting program progress. (See FAR 19.704(a)(9))

10.

Provide assurances the offeror will submit such periodic reports and cooperate in any studies or surveys as may be required by the contracting agency or the Small Business Administration in order to determine the extent of compliance by the offeror (contractor) with the subcontracting plan and with FAR clause 52.219-8. (See FAR 19.704(a)(10)) Provide assurances the offeror will:

a. Submit the Individual Subcontract Report (ISR) and the Summary Subcontract Report

(SSR) using the Electronic Subcontracting Reporting System (eSRS) at http://www.esrs.gov, following the instructions in the eSRS and FAR Clause 52.219-9.

1st reporting period – Oct 1 through March 31

Submit NLT 30 April

2nd reporting period – Oct 1 through September 30 Submit NLT 30 October

Reports are required when due, regardless of whether there has been any subcontracting activity since the inception of the contract or the previous reporting period. When a Contracting Officer rejects a report, a revised report shall be submitted within 30 days of the notice of report rejection.

A separate “Final” ISR is required at contract completion.

Upon award of the contract, the identity of the individual(s) responsible for acknowledging receipt or rejecting the ISR and the SSR will be provided to the awardee.

b. After November 30, 2017, include subcontracting data for each order when reporting subcontracting achievements for indefinite-delivery, indefinite quantity contracts intended for use by multiple agencies;

c. Ensure that its large business subcontractors with subcontracting plans agree to submit the

ISR and/or the the SSR using the eSRS;

d. Provide its prime contract number and its DUNS number, and the e-mail address of the

Government or contractor official responsible for acknowledging or rejecting the reports, to all first tier large business subcontractors with subcontracting plans so they can enter this information into the eSRS when submitting their ISRs;

e. Require that each large business subcontractor with a subcontracting plan provide the prime contract number and its own DUNS number, and the e-mail address of the Government or contractor official responsible for acknowledging or rejecting the reports, to its large business subcontractors with subcontracting plans; and

f. Ensure that the identified contracting officer and small business professional assigned to the contract are included on the eSRS email notification distribution for each report.

*Note 1: If contract value is $30,000 or more and the solicitation includes FAR Clause 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards, ensure additional reporting requirements are met in eSRS in accordance with this clause.

11.

The offeror will maintain at least the following types of records to document compliance with this subcontracting plan: (See FAR 19.704(a)(11))

a. Source lists, guides, and other data identifying small business, HUBZone small business, women-owned small business, small disadvantaged business, veteran-owned small business and service- disabled veteran-owned small business.

b. Organizations contacted to locate small business, HUBZone small business, women-owned small business, small disadvantaged business, veteran-owned small business and service-disabled veteran-owned small business.

On a contract-by-contract basis, records on all subcontract solicitations over $150,000 and indicating for each solicitation:

(i) whether small business, HUBZone SBs, WOSBs, SDBs, VOSBs and SDVOSBs were solicited, and if not, why not; and

(ii) reason why the award was not made to a small business concern.

(iii) written designations from ANCs or Indian Tribes, in accordance with FAR 19.703, if applicable.

Records to support other outreach efforts, e.g., contacts with small business trade associations, business development organizations, and attendance at small business procurement conferences and trade fairs, and frequency of accessing SAM.

Maintain records of internal guidance and encouragement to buyers through:

(i) Workshops, seminars, training; and

(ii) Monitoring performance to evaluate compliance with the program’s requirement.

f.

On a contract-by-contract basis, records to support award data submitted by the contractor to the Government including the name, address, and business size of each subcontractor.

12. Assurances that the offeror will make a good faith effort to acquire articles, equipment, supplies, services, or materials, or obtain the performance of construction work from the small business concerns that the offeror used in preparing the bid or proposal, in the same or greater scope, amount, and quality used in preparing and submitting the bid or proposal. Responding to a request for a quote does not constitute use in preparing a bid or proposal. An offeror used a small business concern in preparing the bid or proposal if – (See FAR 19.704(a)(12))

a. The offeror identifies the small business concern as a subcontractor in the bid or proposal or associated small business subcontracting plan, to furnish certain supplies or perform a portion of the contract; or

b. The offeror used the small business concern’s pricing or cost information or technical expertise in preparing the bid or proposal, where there is written evidence of an intent or understanding that the small business concern will be awarded a subcontract for the related work if the offeror is awarded the contract.

13. Assurances that the contractor will provide the contracting officer with a written explanation if the contractor fails to acquire articles, equipment, supplies, services or materials or obtain the performance of construction work as described in paragraph 12 of this plan. This written explanation will be submitted to the contracting officer within 30 days of contract completion. (See FAR 19.704(a)(13))

14. Assurances that the contractor will not prohibit a subcontractor from discussing with the contracting officer any material matter pertaining to payment to or utilization of a subcontractor. (See FAR 19.704(a)(14))

15. Assurances that the offeror will pay its small business subcontractors on time and in accordance with the terms and conditions of the subcontract, and notify the contracting officer if the offeror pays a reduced or an untimely payment to a small business subcontractor (see 52.242-5). (See FAR 19.704(a)(15))

ATTACHMENT D

CONSTRUCTION & DESIGN EXPERIENCE PROJECT DATA SHEET

Project No. (check one) : CON #1 CON #2 CON #3 CON #4 CON #5

DESIGN #1 DESIGN #2 DESIGN #3 DESIGN #4 DESIGN #5

1. Experience for: Offeror Joint-Venture Other (Explain)

Firm Name:

Address:

Phone Number:

DUNS Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

4. Award Date (mm/dd/yy): Completion Date (mm/dd/yy):

5. Type of work:

New Construction Renovation Repair Alteration Other (explain):

6. Type of Contract/Task Order: (Check ALL that apply)

Firm-Fixed Price Cost/Time and Material Other (explain):

Complete Block 7 for Construction Projects. Complete Block 8 for Design Projects.

7. Construction Project:

Award Amount: Final Price:

Type of Contract/Task Order: (Check ALL that apply)

Design-Build Design-Bid-Build Delivery/Task Order (IDIQ) Other (explain):

If Design-Build, identify the Lead Design Firm:______________________________________________

8. Design Project:

A/E Design Fee: Total Construction Value:

Type of Contract/Task Order: (Check ALL that apply)

Design-Build RFP Development Designer of Record Engineering Services Full Plans & Specs

Other (explain):

9. Provide a detailed description of the project and the relevancy to the project requirements of this RFP (i.e.: unique features, square footage, construction methods), including any sustainable features or USGBC LEED certifications. If design-build, include a description of the design-effort.

10. Provide a detailed description of what work your firm self-performed on this project:

11. Other Information:

ATTACHMENT E

1. The NAVFAC Form PPQ shall be utilized for all evaluations that require a Past Performance Questionnaire (PPQ).

2. Solicitations “Solicitation Submittal Requirements: IF A COMPLETED CPARS EVALUATION IS AVAILABLE, IT SHALL BE SUBMITTED WITH THE PROPOSAL. IF THERE IS NOT A COMPLETED CPARS EVALUATION, the Past Performance Questionnaire (PPQ) included in the solicitation is provided for the offeror or its team members to submit to the client for each project the offeror includes in its proposal for Factor (insert applicable factor number, usually Factor 1, and insert factor title, usually Corporate Experience). AN OFFEROR SHALL NOT SUBMIT A PPQ WHEN A COMPLETED CPARS IS AVAILABLE.

IF A CPARS EVALUATION IS NOT AVAILABLE, ensure correct phone numbers and email addresses are provided for the client point of contact. Completed PPQs should be submitted with your proposal. If the offeror is unable to obtain a completed PPQ from a client for a project(s) before proposal closing date, the offeror should complete and submit with the proposal the first page of the PPQ (Attachment _E__), which will provide contract and client information for the respective project(s). Offerors should follow-up with clients/references to ensure timely submittal of questionnaires. If the client requests, questionnaires may be submitted directly to the Government's point of contact, Barbara Czinder, via email at Barbara.Czinder@navy.mil prior to proposal closing date. Offerors shall not incorporate by reference into their proposal PPQs or CPARS previously submitted for other RFPs. However, this does not preclude the Government from utilizing previously submitted PPQ information in the past performance evaluation.”

ATTACHMENT E

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information

Firm Name:

CAGE Code:

Address:

Entity Identifier Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: FORMCHECKBOX Prime Contractor FORMCHECKBOX Sub Contractor FORMCHECKBOX Joint Venture FORMCHECKBOX Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: FORMCHECKBOX Firm Fixed Price FORMCHECKBOX Cost Reimbursement FORMCHECKBOX Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work FORMCHECKBOX High FORMCHECKBOX Med FORMCHECKBOX Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO NAVFAC WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON NAVFAC SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO NAVFAC. PLEASE CONTACT THE OFFEROR FOR NAVFAC POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING

DEFINITION

NOTE

Contractor Information (Firm Name): ________________________________________________

Client Information (Name): ________________________________________________________

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

3. CUSTOMER SATISFACTION:

4. MANAGEMENT/ PERSONNEL/LABOR

5. COST/FINANCIAL MANAGEMENT

Contractor Information (Firm Name): ________________________________________________

Client Information (Name): ________________________________________________________

6. SAFETY/SECURITY

7. GENERAL

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

Attachment “F” SAFETY DATA SHEET

N69450-19-R-0508

This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. EMR and DART rates shall not be submitted for subcontractors.

Joint Venture (JV) or Partnership: Provide a Safety Data Sheet for each contractor who is part of the JV or partnership; however, only one safety narrative is required.

1. Offeror Name:

Name of JV partner providing the information below (if applicable):

Offeror’s Three Previous Complete Calendar Years of Reported Safety Data:

Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers.

3a. Explain any extenuating circumstances resulting in any EMRs greater than 1.0:

3b. Explain any upward or downward EMR trends:

3c. If you do not have an EMR for a given year, state so here and explain why:

4. Insurance Carrier Information:

Insurance Carrier Name:

6a. Explain any extenuating circumstances resulting in any DART Rates of 3.0 or greater:

6b. Explain any upward or downward DART Rate trends:

6c. If you do not have a DART Rate for a given year, state so here and explain why:

7a. Explain any extenuating circumstances resulting in any TRC Rates of 4.5 or greater:

7b. Explain any upward or downward TRC Rate trends:

7c. If you do not have a TRC Rate for a given year, state so here and explain why:

ALL OFERORS MUST SUBMIT THIS FORM

ATTACHMENT G

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: $

(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:

ACTUAL

SUBCONTRACT GOAL

Completion Date: Contract Dollar Value: $

(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

Name of customer reference for this project: ___________________________________________

(3) Contract Number/Title:

ACTUAL

SUBCONTRACT GOAL

Completion Date: Contract Dollar Value: $

(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

Name of customer reference for this project: ___________________________________________

ALL OFFERORS MUST SUBMIT THIS FORM

ATTACHMENT H

SMALL BUSINESS PARTICIPATION AND COMMITMENT STRATEGY

(OFFEROR’S NAME)

(ADDRESS)

Solicitation or Contract Number

(Title of the Project)

(Location)

(Date Prepared)

INSERT INTRODUCTION/EXECUTIVE SUMMARY (Up to 2 pages maximum) SMALL BUSINESS PARTICIPATION AND COMMITMENT STRATEGY – (Base and Option Years)

1. Estimated value of all planned subcontracting

____% of contract

2. Estimated value of all work to be self-performed

____% of contract

3. Total value of the proposal (sum of 1. and 2. above)

100% of contract

4. Subcontracts for products and services to be awarded under this project.

a. Self-Performed Work:

TYPE OF SERVICE/PRODUCT

$ VALUE OF WORK

TOTAL: $________________

PERCENTAGE OF CONTRACT VALUE (line 3) ________________% If the offeror is a small business, the Government will add self-performed work to the appropriate category(ies) in c. (1) through c. (6) below to calculate overall small business participation rates.

b. Other Than Small (OTS) Business Subcontracts**

NAME OF COMPANY*

$ VALUE OF SUBCONTRACT

PERCENTAGE OF CONTRACT VALUE (line 3) ________________%

c. Small Business (SB) Subcontracts

NAME OF COMPANY*

PERCENTAGE OF CONTRACT VALUE (line 3) ______________%

(1) SMALL DISADVANTAGED BUSINESSES: (SDB)

NAME OF COMPANY*

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

NAME OF COMPANY*

TOTAL: $_______________

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

NAME OF COMPANY*

TYPE OF SERVICES

(4) VETERAN OWNED SMALL BUSINESS: (VOSB)

NAME OF COMPANY*

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

NAME OF COMPANY*

(6) ABILITYONE PROGRAM ORGANIZATIONS

NAME OF ORG*

* For each company/organization listed, describe the nature of commitment to subcontract and whether or not it is legally binding. If unknown/to be determined, so indicate.

** Include any subcontracts to Historically Black Colleges and Universities/Minority Institutions (HBCU/MI) in the OTS Business listing.

NOTES:

1. The dollar sum of lines 4.b and 4.c (excluding (1)-(6)) must equal line 1.

2. Lines 4.c. (1) through 4.c. (6) identify various subcategories of small businesses. Subcontracts to companies that qualify in multiple categories must be reported under each category. For example: A $100,000 subcontract to ABC, a woman-owned, small disadvantaged business that is also a certified HUBZone concern, will be reported as $100,000 on line 4.c., SB, line 4.c. (1), SDB, line 4.c. (2), WOSB and line 4.c.(3), HUBZone concern.

3. Subcontracts to qualified nonprofit agencies participating in the AbilityOne Program are considered small business subcontracts for the purposes of this strategy and any associated small business subcontracting plan.

INSERT SUPPLEMENTAL NARRATIVES (limited to five pages) TO ADDRESS JOINT VENTURE PARTICULARS AND OTHER STRATEGY ELEMENTS SUCH AS THE NATURE OF COMMITMENTS/AGREEMENTS COVERING POST AWARD ROLES, SPECIFIC INITIATIVES AND TOOLS TO ENHANCE SMALL BUSINESS PARTICIPATION AND CAPABILITIES AND HOW SMALL BUSINESS PARTICIPATION RATES WERE DETERMINED.

CONTRACT LEVEL PERFORMANCE SUMMARY

This document summarizes participation (total contract performance, including self-performance and subcontracted efforts) by type of business entity in terms of both dollar value and percentage of total contract value.

Base

Option 1

Option 2

TOTAL

DOLLARS

Total contract value

OTS Business*

SB*

SDB

WOSB

HUBZone SB

VOSB

SDVOSB

ABILITYONE

PERCENTAGES (of total contract value)

OTS Business*

SB*

OTSB + SB

SDB

WOSB

HUBZone SB

VOSB

SDVOSB

ABILITYONE

Include additional option years if applicable

* The sums of the “OTS Business” and “SB” dollars lines (excluding subcategories) must equal the associated dollar values on the “Total dollar value of this contract” line. The sum of “OTS Business” and “SB” percentage lines (again, excluding subcategories) must equal 100% and represent all work to be performed under the contract.

Revised April 2012

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

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