Small_Business_Participation_Form.docx

SMALL BUSINESS PARTICIPATION PLAN ATTACHMENT 004

All Offerors are required to complete a Small Business Participation Plan. Offerors should propose the level of participation of small businesses (as a small business prime and/or small business subcontractors) in the performance of the acquisition relative to the goals set forth in the evaluation of this area.

(a) Check the applicable size and categories for the PRIME Offeror only – Check all applicable boxes:

( ) Other than Small Business Prime Or ( ) Small Business Prime, also categorized as a ( ) Small Disadvantaged Business (SDB) ( ) Women-Owned Small Business (WOSB) ( ) Historical Underutilized Business Zone (HUBZone) Small Business ( ) Veteran-Owned Small Business (VOSB) ( ) Service-Disabled Veteran-Owned Small Business (SDVOSB)

(b) Submit the total combined percentage of work to be performed by Other than Small Businesses, and Small Businesses (include the percentage of work to be performed both by Prime and Subcontractors). Percentages are to be based on total contract value, including options.

Example: If Prime proposes a total contract value of $1,000,000 (including all options), and small business(es) will provide $400,000 in services/supplies as a prime or subcontractor, the % planned for small businesses is 40%; and 60% for other than small business equaling 100%.

Percent of total contract value planned for:

Other than Small Business(es) _____% = $______________ Small Business(es) _____% = $_____________ 100% = Total Contract Value When combined, Other than Small, and Small Business totals must equal 100% Percent of total contract value planned for:

Prime _____% = $_____________ Subcontractors _____% = $_____________ 100% = Total Contract Value

When combined, Prime and Subcontracted totals must equal 100%

(c) Please indicate the total percentage of participation to be performed by each type of subcategory small business. The percentage of work performed by Small Businesses that qualify in multiple small business categories shall be counted in each category:

Example: If the Total Contract Value were $1,000,000 and Prime allocates $200,000 to Subcontractor A (a WOSB and SDVOSB) and $200,000 to Subcontractor B (a SDB and WOSB) the Offeror would allocate $400,000 in the small business category (40%), $200,000 in the SDB Category (20%), $400,000 in the WOSB category (40%), $200,000 in the VOSB (20%), and $200,000 in the SDVOSB (20%) categories.

(d) List principle supplies/services to be performed by Small Businesses:

Example: If a Small Business qualifies also as a WOSB and a SDVOSB, and you can add them to each category below in which they qualify Name of Company Identify Type of Service/Supply Small Business (SB):

Small Disadvantaged Business (SDB):

Women-Owned Small Business (WOSB):

Historically Underutilized Business Zone (HUBZone):

Veteran-Owned Small Business (VOSB):

Service-Disabled Veteran-Owned Small Business (SDVOSB):