SMALL BUSINESS COORDINATION RECORD

1. CONTROL NO. (Optional)

2. PURCHASE REQUEST NO./ 3. TOTAL ESTIMATED VALUE

REQUISITION NO.

(Including options)

5. BUYER
a. NAME (Last, First, Middle Initial)
6. ITEM DESCRIPTION (Including quantity)

b. OFFICE SYMBOL

REPORT CONTROL SYMBOL
4. SOLICITATION NO./CONTRACT MODIFICATION NO.
c. TELEPHONE (Include Area Code) 6a. FEDERAL SUPPLY CLASS/SERVICE
(FSC/SVC) CODE

7. TYPE OF COORDINATION (X one)

a. INITIAL CONTACT

b. MODIFICATION

c. WITHDRAWAL

8. SMALL BUSINESS SIZE STANDARD

a. STANDARD INDUSTRY CODE (SIC)

b. NO. OF EMPLOYEES c. DOLLARS

9. RECOMMENDATION (X as applicable) (If all recommendations are YES NO "No," explain in Remarks.)

a. SECTION 8(a) (X one)

(1) Competitive

(2) Sole Source

b. SMALL DISADVANTAGED BUSINESS (SDB) SET-ASIDE

c. HISTORICALLY BLACK COLLEGES AND UNIVERSITIES/MINORITY INSTITUTIONS (HBCU/MI) SET-ASIDE (List percentage)

d. SMALL BUSINESS (SB) SET-ASIDE (List percentage)

e. EMERGING SMALL BUSINESS SET-ASIDE

f. EVALUATION PREFERENCE FOR SDBs

g. SMALL BUSINESS - SMALL PURCHASE (SB-SP) SET-ASIDE

11. SB PROGRESS PAYMENTS 12. SUBCONTRACTING PLAN

(X one)

REQUIRED (X one)

a. YES
14. REMARKS

b. NO

a. YES

b. NO

10. ACQUISITION HISTORY (X one)

a. FIRST TIME BUY

b. PREVIOUS ACQUISITION (X all that apply)

(1) Section 8(a)

(2) SDB Set-Aside

(3) HBCU/MI Set-Aside

%

(4) SB Set-Aside

%

(5) SB - SP Set-Aside

(6) Other (Specify)

(7) Two or more responsive SB offers on prior acquisition

(8) One or more responsive SDB offer(s) within 10% or award price of prior acquisition

13. SYNOPSIS REQUIRED (X one)

a. YES

b. NO

(If "No," cite FAR 5.202 exception)

15. REVIEWED BY SMALL BUSINESS ADMINISTRATION (SBA) REPRESENTATIVE
a. NAME (Last, First, Middle Initial)

b. SIGNATURE

c. DATE SIGNED (YYMMDD)

16. LOCAL USE

17. CONTRACTING OFFICER (X one)

a. CONCURS

b. REJECTS

c. RECOMMENDATIONS (Document rejections on reverse side)

d. NAME (Last, First, Middle Initial) e. SIGNATURE

f. DATE SIGNED (YYMMDD)

18. SMALL BUSINESS SPECIALIST (X one)

a. CONCURS

b. APPEALS

NOTE: Any change in the acquisition plan this coordination record describes will require return for re-evaluation by the SB specialist.

c. NAME (Last, First, Middle Initial)

d. SIGNATURE

e. DATE SIGNED (YYMMDD)

DD Form 2579, MAY 91 (EG)

Designed using Perform Pro, WHS/DIOR, Jan 95

