SELF PERFORM INFO.docx

PRICE BREAKDOWN AND CALCULATION OF SELF-PERFORMED/SUBCONTRACTED WORK - Appendix 1 Offerors for VISN Bed Rental (NAICS code 339113) must provide at least 50 of the cost of the contract performance incurred for personnel. The minimum percentage shall be spent on the concern's employees or the employees of other eligible service-disabled veteran-owned small business concerns. Provide a breakdown of material and personnel costs, by specification division listed. Clearly identify the personnel costs you will be performing, and the personnel costs of other eligible service disabled veteran-owned small business concerns and/or other than small business concerns. Below is the required format.

THIS DOCUMENT MUST BE COMPLETED FOR EACH BID ITEM.

Bed Rental

Calculation of self-performed personnel costs:

1. Total personnel costs * both prime and all subcontractors: $_____________

2. Subtract all subcontractor personnel costs* that are not SDVOSB companies that will perform work on this contract: $__________________

3. Remainder is ‘Total amount of work to be self-performed under the Contract’: $__________________

4. Self-performed work = Line 3/Line 1 x 100 = __________%

LIST THE NAMES OF ALL SUBCONTRACTORS AND PROVIDE THEIR SOCIOECONOMIC CATEGORYTHAT WILL BE WORKING THE ABOVE BED RENTAL CONTRACT.

I certify the above representations are true and correct to the best of my knowledge.

(Title of Authorized Representative)