Attachment_16-Past_Utilization_of_Small_Business_Participation_Information_Collection_Sheet.pdf

ATTACHMENT 16 – Past Utilization of Small Business Participation Information Collection Sheet

Past Utilization of Small Business Participation Information Collection Sheet

Past Utilization of Small Business Participation Plan Information Collection Sheet - Completed Federal Contracts (Submit this sheet with your Small Business Participation Plan

TO BE COMPLETED BY THE OFFEROR. SUBMIT A SEPARATE SHEET FOR EACH

REFERENCE.

The purpose of this sheet is to collect information regarding compliance with FAR 52.219-8 in previous contracts. The categories of interest are: small business (SB), small disadvantaged business (SDB), veteran-owned small business (VOSB), service-disabled veteran-owned small business (SDVOSB), HUBZone small business, and women-owned small business (WOSB).

Definitions for all terms except small business concern can be found at FAR 2.101. The definition of small business concern can be found at FAR 19.001. For this collection sheet, any concern unable to meet the definition for small business concern shall be considered “other than small business” concern. A SB concern may also qualify in one or more of the other categories.

Small businesses may count themselves as part of the small business compliance. When completing the sheet, the offeror should check all categories that apply.

1. Your firm’s name: 2. Contract number of referenced project:

3. Date completed____________. (Do not submit information for an active contract.)

4. Contract price: $___________________

5. Total amount subcontracted:

$______________ Amount subcontracted to:

LB: $_________________ SB (in this total include all awards to SB, SDB, HUBZone SB, VOSB, SDVOSB, and WOSB):

6. Of the total amount subcontracted to SB, how much was subcontracted to: SDB:

$________________ HUBZone SB:

$_________________ VOSB:

$________________ SDVOSB:

$_________________ WOSB:

7. Contracting Officer’s name and telephone number:

8. In blocks below enter dollar amount for work performed by your firm and by each listed subcontractor:

Name of Firm: Offeror CHECK EACH CATEGORY THAT APPLIES Phone: L

B S B

SD

B

HUBZONE

SB

VOS

B

SDVO

SB

WO

SB

Amount: $ Name of Firm: CHECK EACH CATEGORY THAT APPLIES Phone: L

B S B

SD

B

HUBZONE

SB

VOS

B

SDVO

SB

WO

SB

Amount: $ Name of Firm: CHECK EACH CATEGORY THAT APPLIES Phone: L

B S B

SD

B

HUBZONE

SB

VOS

B

SDVO

SB

WO

SB

Amount: $ Name of Firm: CHECK EACH CATEGORY THAT APPLIES Phone: L

B S B

SD

B

HUBZONE

SB

VOS

B

SDVO

SB

WO

SB

Amount: $ Name of Firm: CHECK EACH CATEGORY THAT APPLIES Phone: L

B S B

SD

B

HUBZONE

SB

VOS

B

SDVO

SB

WO

SB

Amount: $