A07_Attachment_S5_SMALL_BUSINESS_PARTICIPATION_FORM.docx

Attachment S5

SMALL BUSINESS PARTICIPATION PLAN EVALUATION FORM

All Offeror's (both large and small businesses) are required to complete a Small Business Participation Proposal. Offeror's 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 objectives/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:

Or

(b) Submit the total combined percentage of work to be performed by both large and small businesses (include the percentage of work to be performed both by Prime and Subcontractors):

Example: If Prime proposed a price of $1,000,000 (including all options), and small business(es) will provide $250,000 in services/supplies as a prime or subcontractor, the % planned for small business is 25%; and 75% for large business equaling 100%.

Total Percentage planned for Large Business(es) _____% = $__________

Total Percentage planned for Small Business(es) _____% = $__________

(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 may be counted in each category:

Example: Victory Prop Mgt (WOSB and SDVOSB) performing 2%; and Williams Group (SDB, HUBZone and WOSB) performing 3%. Results equate to: SDB 3%; HUBZone 3%; WOSB 5%; SDVOSB 2%; VOSB 2%). SDVOSBs are also VOSBs automatically; however VOSBs are not automatically SDVOSBs.

(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):

Woman-Owned Small Business (WOSB):

Historically Underutilized Business Zone (HUB Zone)

Veteran Owned Small Business (VOSB):

Service Disabled Veteran Owned Small Business (SDVOSB):

Historically Black Colleges and Universities and Minority Institutions (HBCU/MI):

(e) Describe the extent of commitment to use small businesses (for example, What types of commitments, if any, are in place for this specific acquisition either - small business prime, written contract, verbal, enforceable, non-enforceable, joint venturing, mentor-protégé, etc.)

Additional Important Note for Other Than U.S. Small Businesses ONLY.

Small Business Subcontracting Plan is Required (FAR 52.219-9)

Separate from Small Business Participation Plan, other than U.S. Business offeror's must also submit a subcontracting plan meeting the requirements of FAR 52.219-9 and DFARS 252.219-7003 (or DFARS 252.219-7004 if the offeror has a comprehensive subcontracting plan). Other than U.S. Small Businesses must submit acceptable subcontracting plans to be eligible for award. Subcontracting Plans shall reflect and be consistent with the commitments offered in the Small Business Participation Plan.