4b-Submission_Pkg_Vol_2.pdf

JEFFERSON NATIONAL EXPANSION MEMORIAL

SOLICITATION NUMBER: P14PS01930

Luther Ely Smith Square

JEFF-180194

REQUEST FOR PROPOSAL

(RFP)

Volume 2 – Business and Price Proposal

NATIONAL PARK SERVICE

DENVER SERVICE CENTER

SECTION K – REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS

52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (JAN 2014)

(a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 237990.

(2) The small business size standard is $33.5 Million.

(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

(b)(1) If the provision at 52.204-7, System for Award Management, is included in this solicitation, paragraph (d) of this provision applies.

(2) If the provision at 52.204-7 is not included in this solicitation, and the offeror is currently registered in the System for Award Management (SAM), and has completed the Representations and Certifications section of SAM electronically, the offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation.

The offeror shall indicate which option applies by checking one of the following boxes:

[ ] (i) Paragraph (d) applies.

[ ] (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.

(c)(1) The following representations or certifications in SAM are applicable to this solicitation as indicated:

(i) 52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless—

(A) The acquisition is to be made under the simplified acquisition procedures in Part 13;

(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or

(C) The solicitation is for utility services for which rates are set by law or regulation.

(ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $150,000.

(iii) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the provision at 52.204-7, System for Award Management.

(iv) 52.204-5, Women-Owned Business (Other Than Small Business). This provision applies to solicitations that—

(A) Are not set aside for small business concerns;

(B) Exceed the simplified acquisition threshold; and

(C) Are for contracts that will be performed in the United States or its outlying areas.

(v) 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations—Representation.

This provision applies to solicitations using funds appropriated in fiscal years 2008, 2009, 2010, or 2012.

(vi) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold.

(vii) 52.214-14, Place of Performance—Sealed Bidding. This provision applies to invitations for bids except those in which the place of performance is specified by the Government.

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(viii) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the Government.

(ix) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies to solicitations when the contract will be performed in the United States or its outlying areas.

(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.

(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.

(x) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract will be performed in the United States or its outlying areas.

(xi) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include the clause at 52.222-26, Equal Opportunity.

(xii) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.

(xiii) 52.222-38, Compliance with Veterans’ Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial items.

(xiv) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA–designated items; or include the clause at 52.223-2, Affirmative Procurement of Biobased Products Under Service and Construction Contracts.

(xv) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify the use of, EPA–designated items.

(xvi) 52.225-2, Buy American Act Certificate. This provision applies to solicitations containing the clause at 52.225-1.

(xvii) 52.225-4, Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate. (Basic, Alternates I, II, and III.) This provision applies to solicitations containing the clause at 52.225-3.

(A) If the acquisition value is less than $25,000, the basic provision applies.

(B) If the acquisition value is $25,000 or more but is less than $50,000, the provision with its

Alternate I applies.

(C) If the acquisition value is $50,000 or more but is less than $79,507, the provision with its

Alternate II applies.

(D) If the acquisition value is $79,507 or more but is less than $100,000, the provision with its

Alternate III applies.

(xviii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5.

(xix) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan—

Certification. This provision applies to all solicitations.

(xx) 52.225-25, Prohibition on Contracting with Entities Engaging in Certain Activities or

Transactions Relating to Iran-Representation and Certifications. This provision applies to all solicitations.

(xxi) 52.226-2, Historically Black College or University and Minority Institution Representation.

This provision applies to—

(A) Solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions; and

(B) For DoD, NASA, and Coast Guard acquisitions, solicitations that contain the clause at 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns.

(2) The following certifications are applicable as indicated by the Contracting Officer:

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__ (i) 52.219-22, Small Disadvantaged Business Status.

__ (A) Basic.

__ (B) Alternate I.

__ (ii) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products.

__ (iii) 52.222-48, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment Certification.

__ (iv) 52.222-52, Exemption from Application of the Service Contract Act to Contracts for Certain Services–Certification.

__ (v) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA– Designated Products (Alternate I only).

__ (vi) 52.227-6, Royalty Information.

__ (A) Basic.

__(B) Alternate I.

__ (vii) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software.

(d) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically that apply to this solicitation as indicated in paragraph (c) of this provision have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201);

except for the changes identified below [offeror to insert changes, identifying change by clause number, title, date]. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

FAR CLAUSE # TITLE DATE CHANGE

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted on SAM.

(End of provision)

52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

(a) Definitions. As used in this provision— “Administrative proceeding” means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

“Federal contracts and grants with total value greater than $10,000,000” means—

(1) The total value of all current, active contracts and grants, including all priced options; and

(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).

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“Principal” means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

(b) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000.

(c) If the offeror checked “has” in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information:

(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:

(i) In a criminal proceeding, a conviction.

(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.

(iii) In an administrative proceeding, a finding of fault and liability that results in—

(A) The payment of a monetary fine or penalty of $5,000 or more; or

(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.

(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.

(2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.

(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management database via https://www.acquisition.gov (see 52.204-7).

(End of provision) https://www.acquisition.gov/ https://acquisition.gov/far/current/html/52_200_206.html%23wp1137850

General References READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided as described in the Instructions, Conditions, and Notices to Offerors (Section L). Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record. Provide explanations on separate sheets as necessary.

NAME OF CONTRACTOR/OFFEROR:

SURETY

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

CORPORATE BANK

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

CORPORATE BANK

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

INSURANCE COMPANY

Name:

Address:

Name of Agent:

Types of Policies:

Form 3: General References Page 1 of 2

SUBCONTRACTOR

Address:

Name of Contact:

Area of Specialized Work:

Address:

Name of Contact:

Address:

Name of Contact:

MATERIAL SUPPLIER

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL SUPPLIER

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL SUPPLIER

Name:

Address:

Name of Contact:

Types of Material:

Form 3: General References Page 2 of 2

JEFF - 181202

CPS - 1

CONTRACT

LINE ITEM

NUMBER

(CLIN)

CONTRACT LINE ITEM (CLI) TITLE QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL PRICE

Furnish and install complete all work as shown and described in the project documents.

Lump Sum

CONTRACT PRICE SCHEDULE

SOLICITATION NUMBER: P14PS01930

PARK - PMIS: JEFF - 180194

DEVELOPED AREA: Approx. 2.5 Acres

All measurement and payment information is included in the project specifications, Section 012700.

Notice: Offerors are required to submit, a minimum, an offer that conforms to the solicitation documents with pricing for Base line items. Failure to do so may render the proposal unacceptable. On lump-sum line items, provide the total price only. Round totals and extended prices to whole dollars. Pricing will be evaluated based on what is determined to be the best value to the Government.

TOTAL BASE PRICE (Contract Line Item Number 1) ------------------------------------

PROJECT TITLE: Luther Ely Smith Square (Contract 5)

SMALL, HUBZONE SMALL, SMALL DISADVANTAGED, WOMEN-OWNED

VETERAN-OWNED SMALL BUSINESS SUBCONTRACTING PLAN

DATE___________

CONTRACTOR: _________________________________________________________________________________________

ADDRESS: _____________________________________________________________________________________________

SOLICITATION OR CONTRACT NUMBER: ___________________________________________________________________

ITEM/SERVICE: _________________________________________________________________________________________

The following, together with any attachments, is hereby submitted as a Subcontracting Plan to satisfy the applicable requirements of Public Law 95-507 as implemented by OFPP Policy Letter 80-2.

The National Park Service (NPS) subcontracting goals for the participation of small business; small disadvantaged business and small women-owned business at a minimum are as follows: All Small Business Concerns – 40%; Small Disadvantaged Business Concerns –5.0%; Small Women-Owned Business Concerns – 5.0%; Hubzone Small Business Concerns – 3.0%; Veteran-Owned Small Business Concerns – 3.0%; Service-Disabled Veteran Owned Business Concerns – 3.0%.

If your firm indicates in Item No. 1 below a lesser percentage than the subcontracting goals of the NPS, specify in the space provided the reason(s) your firm cannot meet these goals. ________________________________________________________

1. (a) The following percentage goals (expressed in terms of a percentage of total planned subcontracting dollars) are applicable to the contract cited above or to the contract awarded under the solicitation cited.

(i) Small Business Concerns: _____% of total planned subcontracting dollars under this contract will go to subcontractors who are small business concerns.

(ii) HUBZone Small Business Concerns:_____% of total planned subcontracting dollars under this contract will go to subcontractors who are HUBZone small business concerns. This percentage is included in the percentage under 1(a)(i) above, as a subset.

(iii) Small Disadvantaged Business Concerns: _____% of total planned subcontracting dollars under this contract will go to subcontractors who are small business concerns owned and controlled by socially and economically disadvantaged individuals. This percentage is included in the percentage shown under 1.(a)(i), above, as a subset.

(iv) Women-Owned Small Business Concerns: _____% of total planned subcontracting dollars under this contract will go to subcontractors who are women-owned small business concerns. This percentage is included in the percentage shown under 1.(a)(i), above, as a subset.

(v) Veteran-Owned Small Business Concerns: _____% of total planned subcontracting dollars under this contract will go to subcontractors who are veteran-owned small business concerns. This percentage is included in the percentage shown under 1.(a)(i), above, as a subset.

(vi) Service-Disabled Veteran-Owned Small Business Concerns: ____ % of total planned subcontracting dollars under this contract will go to subcontractors who are service-disabled veteran-owned small business concerns. This percentage is included in the percentage shown under 1(a)(i) above, as a subset.

(b) The following dollar values correspond to the percentage goals shown in (a) above.

(i) Total dollars planned to be subcontracted to small business concerns: $____________________.

(ii) Total dollars planned to be subcontracted to HUBZone small business concerns: $________________. This dollar amount is included in the amount shown under 1.(b)(I), above as a subset.

(iii) Total dollars planned to be subcontracted to small disadvantaged business concerns: $____________________.

This dollar amount is included in the amount shown under 1.(b)(i), above, as a subset.

(iv) Total dollar planned to be subcontracted to women-owned small business concerns: $_____________________.

This dollar amount is included in the amount shown under 1.(b)(i), above, as a subset.

(v) Total dollar planned to be subcontracted to veteran-owned small business concerns: $_____________________.

This dollar amount is included in the amount shown under 1.(b)(i), above, as a subset.

(vi) Total dollar planned to be subcontracted to service-disabled veteran-owned small business concerns:

$________________. This dollar amount is included in the amount shown under 1(b)(i) above, as a subset.

(vii) Total dollar planned to be subcontracted to 8(a) small business concerns: $________________. This dollar amount is included in the amount shown under 1(b)(i) above, as a subset.

(c) The total estimated dollar value of all planned subcontracting (to all types of business concerns) under this contract is

(d) The following principal products and/or services will be subcontracted under this contract, and the distribution among small business, HUBZone small business, small disadvantaged business concerns, women-owned small business and veteran-owned small business concerns is as follows:

(Products/services planned to be subcontracted to small business concerns are identified by *; to HUBZone small business concerns; by **; to small disadvantaged business concerns by ***; to women-owned small business concerns by **** and to veteran-owned small business concerns *****.)

(e) The following method was used in developing subcontract goals (i.e., statement explaining how the product and service areas to be subcontracted were established, how the areas to be subcontracted to HUBZone small, small disadvantaged, small women-owned business and small veteran-owned business concerns' capabilities were determined, to include identification of source lists utilized in making those determinations).

(f) Indirect and overhead costs (check one below):

[ ] have been [ ] have not been included in the goals specified in 1(a) and 1(b).

(g) If "have been" is checked, explain the method used in determining the proportionate share of indirect and overhead cost to be allocated as subcontracts to small business concerns, HUBZone small business, small disadvantaged business, small women-owned business and veteran-owned business concerns.

2. The following individual will administer the subcontracting program:

Name: _________________________________________________________________________________________________

Address & Telephone: ____________________________________________________________________________________

Titles: _________________________________________________________________________________________________

This individual's specific duties, as they relate to the firm's subcontracting program, are as follows:

General overall responsibility for this company's Small Business Program, the development, preparation, and execution of individual subcontracting plans and for monitoring performance relative to contractual subcontracting requirements contained in this plan, including, but not limited to:

(a) Developing and maintaining bidders lists of small, HUBZone small, small disadvantaged, women-owned small and veteran-owned small business concerns for all possible sources.

(b) Ensuring that procurement packages are structured to permit small, HUBZone small, small disadvantaged, women-owned small and veteran-owned small business concerns to participate to the maximum extent possible.

(c) Assuring inclusion of small, HUBZone small, small disadvantaged, women-owned small and veteran-owned small business concerns in all solicitations for products or services that they are capable of providing.

(d) Reviewing solicitations to remove statements, clauses, etc, which may tend to restrict or prohibit small business, HUBZone small, small disadvantaged, women-owned small and veteran-owned small business participation.

(e) Ensuring periodic rotation of potential subcontractors on bidders' lists.

(f) Ensuring that the bid proposal review board documents its reasons for not selecting low bids submitted by small, HUBZone small, small disadvantaged, women-owned small and veteran-owned small business concerns.

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

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

(i) Conducting or arranging for conduct of motivational training for purchasing personnel pursuant to the intent of P.L.

95-507.

(j) Monitoring attainment of proposed goals.

(k) Preparing and submitting periodic subcontracting reports required.

(l) Coordinating contractor's activities during the conduct of compliance reviews by Federal agencies.

(m) Coordinating the conduct of contractor's activities involving its small, HUBZone small, small disadvantaged, women-owned small and veteran-owned small business subcontracting program.

(n) To help new suppliers the following duties are added (or deleted) to those specified above:

3. The following efforts will be taken to assure that small, HUBZone small, small disadvantaged business concerns, women-owned small business concerns and veteran-owned small business concerns will have an equitable opportunity to compete for subcontracts:

(a) Outreach efforts will be made as follows:

(i) contacts with minority, women-owned and small business trade associations,

(ii) contacts with business development organizations;

(iii) attendance at small, women-owned small business and minority business procurement conferences and trade fairs;

(iv) sources will be requested from SBA's PRO-Net system.

(b) 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.

(c) Small, HUBZone small, small disadvantaged, women-owned and veteran-owned small business concern source lists, guides, and other data identifying small and small disadvantaged, women-owned and veteran-owned small business concerns will be maintained and utilized by buyers in soliciting subcontracts.

(d) Additions to (or deletions from) the above listed efforts are as follows:

4. The bidder (contractor) agrees that the clause entitled Small, HUBZone Small, Small Disadvantaged, Women-Owned Small and Veteran-Owned Small Business Subcontracting Plan (FAR 52.219.9) will be included in all subcontracts which offer further subcontracting opportunities, and all subcontractors except small business concerns who receive subcontracts in excess of $650,000 will be required to adopt and comply with a subcontracting plan similar to this one. Such plans will be reviewed by comparing them with the provisions of Public Law 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, HUBZone small, women-owned small business, small disadvantaged, and veteran-owned small business 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 subcontractors' facilities to review applicable records and subcontracting program progress.

5. The bidder (contractor) agrees to submit such periodic reports and cooperate in any studies or surveys as may be required by the contracting agency or the SBA in order to determine the extent of compliance by the bidder with the subcontracting plan and with the clause entitled Small Business Subcontracting Plan (FAR 52.219.9) contained in the contract.

6. The bidder (contractor) agrees that he will maintain at least the following types of records to document compliance with this subcontracting plan:

(a) Small, HUBZone small, small disadvantaged, women-owned, veteran-owned small business concern source lists, guides, and other data identifying SB/SDBA vendors.

(b) Organizations contacted for small, HUBZone small, small disadvantaged, women-owned and veteran-owned small business sources.

(c) On a contract-by-contract basis, records on all subcontract solicitations over $100,000, indicating on each solicitation (1) whether small business concerns were solicited, and if not, why not; (2) whether HUBZone small, small disadvantaged, women-owned and veteran-owned small business concerns were solicited, and if not, why not; and (3) reasons for the failure of solicited small, HUBZone small, small disadvantaged, women-owned or veteran-owned small business concerns to receive the subcontract award.

(d) Records to support other outreach efforts: Contacts with Minority and Small Business Trade Associations, etc. Attendance at small, women-owned small business and minority business procurement conferences and trade fairs.

(e) Records to support internal activities to guide and encourage buyers; workshops, seminars, training programs, etc;

monitoring activities to evaluate compliance.

(f) On a contract-by-contract basis, records to support subcontract award data to include name and address of subcontractor.

(g) Records to be maintained in addition to the above are as follows:

Signed:_______________________________________________________________

Typed name:__________________________________________________________

Title:_________________________________________________________________

Date:_________________________________________________________________

Plan accepted by: ______________________________________________________ Contracting Officer

Date:_________________________________________________________________

Subcontractor Reference READ CAREFULLY: The purpose of this form is for the offeror to list certain subcontractors identified in the Instructions, Conditions, and Notices to Offerors (Section L) who are considered critical to the successful accomplishment of the project. Use as many sheets as necessary. These subcontractor references should include additional relevant projects similar to the work described in the plans and specifications. Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

SUB CONTRACTOR (PROPOSED):

ADDRESS:

TELEPHONE NUMBER: ( )

# PROJECT

NAME:

Name of Owner:

Location:

Prime Contractor Telephone Number:

Subcontract $ Value:

Dates of Construction:

Reference Name and Telephone Number: ( ) .

Dates of Construction:

DESCRIPTION & SCOPE OF WORK

SPECIFIC AREAS OF EXPERIENCE (SEE INSTRUCTIONS FOR THE SUBMISSION OF OFFERS AND OTHER

INFORMATION – CAPABILITY CRITERIA):

Subcontractor Reference Page 1 of 2

DESCRIPTION & SCOPE OF WORK {continuation}

SPECIFIC AREAS OF EXPERIENCE (SEE INSTRUCTIONS FOR THE SUBMISSION OF OFFERS AND OTHER INFORMATION – CAPABILITY CRITERIA) {continuation}:

Subcontractor Reference Page 2 of 2

INSERT OFFEROR'S

COMPANY NAME:

LEVEL OF COMMITMENT TO USE SMALL BUSINESS CONCERNS

SUBCONTRACTOR NAME

Socio- Economic

Status

Description of Supplies/Service Subcontracted

Total Estimated

Subcontract Value

SB

Estimated

Subcontract Value

SDB

Estimated

Subcontract Value

HZSB

Estimated

Subcontract Value

SDVO

Estimated

Subcontract Value

WOSB

Estimated

Subcontract Value

Explain and provide supporting documentation regarding the level of commitments to use SB concerns (for example, what types of committments, if any, are in place for this specific acquisition as a prime and/or written contract, verbal, enforceable, non-enforceable, joint venturing, mentor-protege, etc.

ABC Company 550.00$ 500.00$ 50.00$ XYZ Company -$

2.00$ 2.00$ 2.00$ 2.00$ 2.00$ 2.00$

200.00$ 200.00$ 3.00$ 3.00$

3.00$ 3.00$

Total Subcontracted Value 762.00$ 2.00$ 503.00$ 202.00$ 53.00$ 2.00$ Total Contract Value $10,000,000.00 $10,000,000.00 $10,000,000.00 $10,000,000.00 $10,000,000.00 $10,000,000.00 Subcontracted Value Percent 0.0076% 0.0000% 0.0050% 0.0020% 0.0005% 0.0000%

Mark the appropriate socio-economic category of the subcontractor Small Business (SB) concern.

SB = Small Business, SDB = Small Disadvantaged SB, HZSB = HubZone SB, SDVO = Service-Disabled Veteran Owned SB, WOSB = Woman Owned SB

SUBCONTRACTED SUPPLIES AND/OR SERVICES

NOTE 1: List the type of supplies and/or services to be subcontracted, estimated dollars, and the corresponding socio-economic status of the businesses

NOTE 2: If supplies or services are projected to be subcontracted to small, small disadvantaged, women-owned, service disabled veteran owned, hubzone, or veteran owned small businesses, but large businesses are subsequently substituted, the contracting officer shall be provided with timely written notification.