Attachment_16_-_Utilization_of_Small_Biz_Collection_Sheet_Updated_13_Feb_2018.pdf

W911WN-18-R-3005

ATTACHMENT 16, Factor 4, Subfactor 4(B) Past Utilization of Small Business Collection Form

This form is for use for Small Business Concerns, and “Other-than-Small-Business” concerns (a.k.a. Large Business) where either no subcontracting plan was required, in accordance with FAR Clause 52.219-9, OR the contract was not subject to the Federal Acquisition Regulation, the sample form to follow may be used to submit this data with the offer. The offeror may use its own format, provided it provides substantially the same information contained in the sample form. Add additional rows to accommodate additional data. Do not submit this form if the contract is reportable in eSRS (see below) or has paper copies of Individual Subcontracting Reports submitted via

SF294.

The purpose of this sheet is to collect information regarding compliance with the intent of FAR Clause 52.219-8, Utilization of Small Business, in previous contracts. This information will be used, in part, to determine realism of the Offeror’s Subfactor A, Small Business Participation Proposal (SBPP) contained in its Offer.

The Offeror shall identify the extent of utilization (to include self-performance, if small) of small businesses in past contracts by indicating the level of participation/subcontracting dollars and percentage of the total contract price for each of the following small and socioeconomic categories: Small Business (SB), Small Disadvantaged Business (SDB), Veteran-Owned Small Business (VOSB), Service-Disabled Veteran-Owned Small Business (SDVOSB), Historically Underutilized Business Zone (HUBZone) Small Business, Woman-Owned Small Business (WOSB).

Size Standard of the NAICS code applicable to this solicitation is $15M average revenues; those meeting this standard are considered “small” businesses. Those not meeting this standard are considered “other-than-small” business.”

“Other-Than-Small-Business” (OTSB) is indicated by ‘LB” on the form, however be aware that if a partner is anything other than small, even if it is a non-profit, for example, it automatically is classified as OTSB and the dollars are included in the LB tabulation.

Definitions of the socioeconomic categories are found at FAR 2.101. If a small business can be classified in more than one category, check each applicable category. Small business self-performance is also counted in the appropriate category(ies). Provide total dollar amounts for each category.

Note: if the offeror has past contracts subject to 52.219-9, Small Business Subcontracting Plan, and are reportable in the Electronic Subcontracts Reporting System (eSRS), submit most recent eSRS reports for each referenced contract as stipulated in the solicitation. If an offeror has past contracts containing small business subcontracting plans that were NOT reportable in eSRS, submit the PAPER COPY of SF 294, Individual Subcontracting Report for each. If neither applies, submit this form. Do NOT submit data for any contract for which your firm was not the prime contractor or the majority member of a joint venture or other teaming arrangement, and for which you were not responsible for making small business subcontracting and goal achievement decisions.

W911WN-18-R-3005

PAST UTILIZATION OF SMALL BUSINESSES COLLECTION FORM

For contracts not subject to FAR 52.219-9, Small Business Subcontracting Plan

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

Insert rows below where needed. Offeror may submit on current contracts provided the level of completion is at least 75% or more. Socio-Economic Category Abbreviations: SB, SDB, VOSB, SDVOSB, HUBZ, WOSB

1. Offeror Name: __________________________________________________________________

2. Contract Number: _______________________ 3. Total Contract Price:______________________

4. Contracting Officer POC & Telephone #:

Name:______________________________

Tel no:______________________________

5. Completed: ____YES _____No (must be at least 75% completed to reference herein) 6. Date of Completion: ____________________

7. Total Amount performed by all Small Business (all categories, incl. self-performance, if offeror is small) $____________________________

7a. Of the total performed by Small Business in Block 7, indicate the dollar value applicable to each socio-economic category below:

SDB: $_________________________ VOSB: $__________________________

WOSB: $_________________________ SDVOSB: $__________________________

HUBZ: $_________________________

8. Total Amount performed by Large Business $____________________________

9. Total performed by both large & small business (Block 7 + Block 8 = Block 3)

10. Complete for each participant in the contract, Offeror and all subcontractors. Insert more rows where necessary. Check each category that applies. Enter the total amount of the subcontract performed. Total of all subcontracts listed shall equal the total contract price listed in #3 above.

Name of Firm/Business Size: (OFFEROR) _______________________________$_________________

LB SB SDB VOSB SDVOSB WOSB HUBZ

Name of Firm/Business Size: (Subcontractor) ____________________________$__________________

LB SB SDB VOSB SDVOSB WOSB HUBZ

Name of Firm/Business Size: ___________________________________________$__________________

LB SB SDB VOSB SDVOSB WOSB HUBZ