S02 Self-Performance Worksheet Small Business.pdf

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Attached to
S222--Septic waste removal for Building T-35 at the San Francisco Veterans Affairs Medical Center
Solicitation number
36C26122Q0295
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File Type Posted
S05 - QA RFI Response 1.pdf PDF
36C26122Q0295 0001.docx DOCX document
P07 - 2015-5637 Rev. 20.pdf PDF
Past Performance Survey.pdf PDF
36C26122Q0295_1.docx DOCX document

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QUOTOR’s SELF PERFORMANCE WORKSHEET

As a Small Business set-aside in accordance with Federal Acquisition Regulation (FAR) 52.291-6, Limitations on Subcontracting – Monitoring and Compliance applies in accordance with VAAR 852.219-74. To demonstrate compliance please complete this worksheet and submit with quote. The Contracting Officer may ask questions about responses on this form.

Any such questions will be communications related to responsibility; it will not be considered discussions.

Vendors are required to complete this Worksheet and submit with quote.

a) Quotor’s total proposed price (should be same amount shown in price worksheet for the total): $

b) Total amount to be paid to subcontractors (non-Small Business): $

c) The difference of the amount shown in a) minus the amount shown in b): $

List of intended subcontractors for this project and the value of those subcontracts:

Company DUNS Amount

List of “Self-Performed” work activities by the Small Business (this should be consistent with the response in the technical evaluation factor):

List of subcontracted work activities:

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