Past_Utilization_of_Small_Business_Collection_Sheet.docx

ATTACHMENT 17, Factor 4, Subfactor 4(b) Past Utilization of Small Business Collection Sheet 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.

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. 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 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 500 employees; those meeting this standard are considered “small” businesses. Those not meeting this standard are considered “other-than-small” business.” “Other-Than-Small-Business” is indicated by ‘LB” on the form.

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, submit most recent eSRS (Electronic Subcontract Reporting System) reports for each referenced contract as stipulated in paragraph 3.4, Small Business Participation” of this solicitation.

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. 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: __________________________________________________________________

Tel no:______________________________

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: $_________________________

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.

Name of Firm/Business Size: (OFFEROR) ________________________________________________

Name of Firm/Business Size: (Subcontractor) ______________________________________________

Name of Firm/Business Size: ___________________________________________________________