Attachment 0004 SBP Certification Form-Subcontractor.docx
DOCX document 28 KB Posted
- Solicitation number
- W912CH24R0177
- Issued by
-
Department of the Army
About this file
This is a Certification Form for Small Business Size and Socioeconomic Status designed for proposed subcontractors who are not registered in the System for Award Management (SAM). The form is intended to be used in conjunction with solicitation W912CH-24-R-0177 for the Diagnostic Kit Assembly High Voltage/Low.
The prime offeror must obtain this certification from any small business subcontractor listed in the proposal that lacks SAM registration. Before distributing to subcontractors, the prime must complete the Solicitation Number, NAICS code applicable to the subcontractor's work, and the corresponding size standard. Subcontractors then certify their small business status by checking applicable categories: Small Business (SB), Small Disadvantaged Business (SDB), Woman Owned Small Business (WOSB), Veteran Owned Small Business (VOSB), or Service Disabled Veteran Owned Small Business (SDVOSB). The form explicitly notes that subcontractors cannot self-certify as 8(a) SDB or HUBZone SB entities, as these require formal SBA certification and SAM registration. The certification must be signed and dated by an authorized company official and references FAR 2.101, FAR Clause 52.219-8, and 13 CFR 121.103 regarding SBA affiliation determinations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Question and Answer_3 W912CH-24-R-0177.docx | DOCX document | |
| Question and Answer_2 W912CH-24-R-0177.docx | DOCX document | |
| Question and Answer W912CH-24-R-0177.docx | DOCX document | |
| Attachment 0006 SBP Factor Workbook.xlsx | XLSX spreadsheet | |
| Attachment 0005 SBP Factor Workbook Instructions.docx | DOCX document | |
| First Article Waiver Worksheet.pdf |
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Text version
Certification Form Small Business Size and Socioeconomic Status For Proposed Subcontractors Not Registered in the System for Award Management (SAM) Instructions for Prime Offeror:
1. Obtain this certification from any small business listed in the proposal that is not registered in SAM at https://www.sam.gov.
2. Before sending to a subcontractor to fill in, insert the Solicitation Number, NAICS code associated with the work to be done by the subcontractor, and the size standard for that NAICS code. Insertion of subcontract number or other internal tracking code is optional.
Instructions for Subcontractor:
1. Do not fill in this form if the NAICS code or one of the size standard fields has not been filled in by the prime offeror.
2. Fill in the other fields below. {The fields will expand as you type.}
3. Provide Name, Title, and Signature of official authorized to sign for the company and the date.
Solicitation Number: W56HZV-{ }-{ }-{ } Subcontract Number or Other Internal Tracking Code (Optional): { }
| Company Name: | { } | |
| Address: | { } |
I hereby certify that for the North American Industry Classification System (NAICS) code of { } defined in https://www.census.gov/eos/www/naics/ with a size standard of { } employees / $ { } average annual receipts assigned at https://www.sba.gov/contracting/getting-started-contractor/make-sure-you-meet-sba-size-standards, the above named business is a (check all that apply):
|_| Small Business (SB) |_| Small Disadvantaged Business (SDB) |_| Woman Owned Small Business (WOSB) |_| Veteran Owned Small Business (VOSB) |_| Service Disabled Veteran Owned Small Business (SDVOSB) as defined in Federal Acquisition Regulation (FAR) 2.101, FAR Clause 52.219-8, and taking into consideration the 13 CFR 121.103 “How does SBA determine affiliation” at http://www.ecfr.gov.
The contractor may self-certify in the above categories. A Contractor cannot self-certify as an 8(a) Small Disadvantaged Business or a Historically Underutilized Small Business Zone Small Business (HUBZone SB). These require certification by the Small Business Administration (SBA) and registration in the System for Award Management (SAM) and the SBA’s Dynamic Small Business Search Database.
Official authorized to sign for the company
| Name: | { } |
| Title: | { } |
Electronic Signature: { } or Handwritten Signature: _______________________________________________________________
| Electronic Date: | { } |
| or Handwritten Date: | ___________________ |
Form version: 27 Mar 2019
File details come from the government source that posted it. Updated .