Subcontractor Verification SDVOSB Work Sheet.doc

Date Contractor Point of Contact

Business Name

Address

Address

Subject:

Confirmation of Percentage of Work Performed by Contractor

Request for Quote 36C10E20Q0259, RO355 Regional Office Paging System.

The VA requires verification whether subcontractors are performing contract work or what percentage(%) of work is performed by subcontractors under subject Request for Quotation.

If subcontractors will be used, please complete the enclosed overview of contractor and subcontractor work and submit with your quote a s pdf document sperate attachment. Also provide copies of any signed subcontractor agreements.

Please complete and return this overview to the undersigned with your submission via email as a separated pdf document. If no subcontractors are utilized in performing services under this contract, complete the below certification and return this letter to the undersigned with quote.

My employees perform 100% of the work required on this contract.

Signature

Overview of Contractor and Subcontractor Work

Reference: Contract No.

Title:

SDVOSB/VOSB Company:

Please provide the following information to identify and calculate the cost of the work self-performed and what is subcontracted.

Clearly describe the work self-performed and the work to be subcontracted. Description to include trade descriptions, equipment, equipment maintenance, percentage of personnel, percentage of supervision, etc, and work to be performed. For each subcontractor provide their business name, address, phone number, and DUNs Number if available.

Percentage of

Description of Work

Contractor Contract Services

Total percentage of work performed by (prime contractor)

Total percentage of work performed by subcontractors

Calculation of self-performed contract personnel costs:

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

2. Subtract all subcontractor personnel costs* 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 = _____%

*personnel costs include laborers, mechanics, other tradesmen, and office personnel directly charged to the contract.

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

(Contractor)

Title