Atch12 Small Business Participation Plan Form

FA8681-27-R-B002

ATTACHMENT 12

SMALL BUSINESS PARTICIPATION PLAN

INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

All Offerors (both large business concerns and small business concerns) are required to complete a Small Business Participation Plan to be evaluated under Small Business Participation Evaluation Factor. The Offeror shall articulate how the Offeror intends to meet the small business objectives described in the Small Business Evaluation Factor. --------------------------------------------------------------------------------------------------------------------------------------------Small Business Participation Plan (Form) (1) Check the applicable size and categories for the PRIME Offeror -- Check all applicable boxes: { } Large Prime
Or
{ } Small Business Prime; also categorized as a
{ } Small Disadvantaged Businesses
{ } Woman-Owned Small Business
{ } HUB Zone Small Business
{ } Service Disabled Veteran Owned Small Business

(2) Submit the total combined percentage (must equal 100%) 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 proposes 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 businesses is 25%; and 75% for large business equaling 100%.
Percentage of Total Contract Dollars/Price
Total Percentage planned for Large Business (es)

_%

Total Percentage planned for Small Business (es)

%
Total: 100%

(3) Please indicate the total percentage of participation to be performed by each type of small business. The percentage of work performed by Small Businesses that qualify in multiple small business categories may be counted in each category:
Example: Construction Company X (WOSB and SDVOSB) performing 2%; and Electrical Contractor Z (HubZone and WOSB) performing 3%. Results equate to: HubZone 3%; WOSB 5%; SDVOSB 2%; VOSB 2%;). SDVOSBs are also VOSBs automatically; however VOSBs are not automatically SDVOSBs. Small Disadvantaged Businesses:
HUB Zone Small Business:
Woman Owned Small Business:
Service Disabled Veteran Owned SB

%
%
%
%

(4) 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.

FA8681-27-R-B002

Name of Company
Small:

Identify Type of Service/Supply