Self Performace Worksheet.docx

DOCX document 14 KB Posted

Attached to
H312--Fire Extinguisher Safety (Monthly and Annual) Inspections
Solicitation number
36C26123Q0474
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File Type Posted
WD2015-5651-Rev17-Sonoma.pdf PDF
S02 RFQ 36C26123Q0474 Fire Extinguishers.pdf PDF
WD2015-5637-Rev23-San Francisco.pdf PDF
36C26123Q0474_1.docx DOCX document
WD2015-5623-Rev20-Alameda.pdf PDF
WD2015-5673-Rev17-Humboldt.pdf PDF

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VENDOR’s SELF PERFORMANCE WORKSHEET

As a Service-Disabled Veteran-Owned Small Business set-aside in accordance with VA Acquisition Regulation (VAAR) 852.219-10, 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) Vendor’s total proposed price (should be same amount shown in price worksheet for the total): $_______________

b) Total amount to be paid to subcontractors (non-SDVOSBs): $_______________

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:

CompanyDUNSAmount
____________________________________________$_____________
____________________________________________$_____________

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

List of subcontracted work activities:

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