GENERAL SERVICES ADMINISTRATION ACQUISITION MANUAL (GSAM)

### Appendix 519B—Subcontracting Plan Evaluation Checklist

CHECKLIST FOR REVIEW OF SUBCONTRACTING PLAN
1. POINTSOF CONTACT, ADDRESS WITH ROOM NUMBER & SYMBOL PHONE & FAX NUMBERS Prepared by: _________________________ Phone: ___________ FAX: _____________ GSA, (Insert Service & Symbol) PCO is: _________________________ Phone: ___________ FAX: _____________ | 2. ADMINISTRATIVE CONTRACTING OFFICE, ADDRESS, PHONE & FAX NUMBERS NAME: Address: Telephone: FAX:
3. SOLICITATION NUMBER | 4. CONTRACT NUMBER
5. CONTRACTOR NAME, ADDRESS, DUNS NUMBER, AND CONTACT INFORMATION Phone: FAX: DUNS No.: E-Mail: | 6. SUBCONTRACTING PLAN ADMINISTRATOR NAME, ADDRESS, & CONTACT INFORMATION Phone: FAX: E-Mail:
7. PLACE OF PERFORMANCE ( If different from No. 5 ) | 8. TYPE OF CONTRACT q SEALED BID or q NEGOTIATED q SCHEDULE or q NON-SCHEDULE
9. a. CONTRACT PERIOD OR OPTION PERIOD Thru | 9. b. DATE OF AWARD AND DATE OF OPTION | 10. ESTIMATED CONTRACT VALUE (EACH PERIOD) OR ESTIMATE ANNUAL SALES FOR THIS CONTRACT $

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11. DESCRIPTION OF PRODUCTS OR SERVICES
12. TYPE OF SUBCONTRACTING PLAN BEING SUBMITTED p INDIVIDUAL CONTRACT PLAN | p INDIVIDUAL INCORPORATING MASTER PLAN | COMPANY-WIDE PLAN FOR COMMERCIAL ITEMS p COVERS ANNUAL PERIOD THRU

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PROPOSED TARGET GOALS ESTABLISHED | Percent | Dollar Amount | PCO/ACO ACCEPTABLE | SBTA ACCEPTABLE | SBA/PCR ACCEPTABLE
--- | --- | --- | --- | --- | ---
Yes | No | Yes | No | Yes | No
(1) TOTAL SUBCONTRACTING PLANNED (To large & all small business concerns) | 100 |  |  |  |  |  |  |
(2)(a) TO ALL SMALL BUSINESSES (Includes ANCs or Indian Tribes, veteran-owned small, service-disabled veteran-owned small, HUBZone small, small disadvantaged, and women-owned small concerns) |  |  |  |  |  |  |  |
(2)(b) TO VETERAN-OWNED SMALL BUSINESS (VOSB) Percent of Total |  |  |  |  |  |  |  |
(2)(c) TO SERVICE-DISABLED VETERAN-OWNED SMALL (SDVOSB) Percent of Total and subset of VOSB |  |  |  |  |  |  |  |
(2)(d) TO HUBZONE SMALL BUSINESS (HUBZone) Percent of Total |  |  |  |  |  |  |  |
(2)(e) TO SMALL DISADVANTAGED BUSINESS (SDB Includes ANCs or Indian Tribes) Percent of Total |  |  |  |  |  |  |  |
(2)(f) TO WOMEN-OWNED SMALL BUSINESS (WOSB) Percent of Total |  |  |  |  |  |  |  |

13. CHECKLIST

(3) DESCRIPTION OF PRINCIPAL TYPES OF SUPPLIES AND SERVICES TO BE SUBCONTRACTED, AND IDENTIFICATION OF TYPES PLANNED FOR SUBCONTRACTING TO EACH BUSINESS CATEGORY (i.e. SMALL, VOSB, SDVOSB, HUBZ, SDB, and WOSB CONCERNS); |  |  |  |  |  |
(4) DESCRIPTION OF METHOD USED TO DEVELOP GOALS; |  |  |  |  |  |
(5) DESCRIPTION OF METHOD USED TO IDENTIFY POTENTIAL SOURCES FOR SOLICITATION PURPOSES; |  |  |  |  |  |
(6) STATEMENT AS TO WHETHER OR NOT THE OFFEROR INCLUDED INDIRECT COSTS IN ESTABLISHING SUBK GOALS AND DESCRIPTION OF METHOD USED TO DETERMINE THE PROPORTIONATE SHARE OF INDIRECT COSTS TO BE INCURRED WITH EACH BUSINESS CONCERN; |  |  |  |  |  |
(7) NAME OF INDIVIDUAL WHO WILL ADMINISTER THE OFFEROR’S SUBCONTRACTING PROGRAM AND A DESCRIPTION OF THEIR DUTIES; (Include phone & fax numbers and email address of contact for further questions.) |  |  |  |  |  |
(8) DESCRIPTION OF EFFORTS THE OFFEROR WILL MAKE TO ASSURE EQUITABLE OPPORTUNITY TO COMPETE FOR SUBCONTRACTS; |  |  |  |  |  |
(9) FLOW DOWN ASSURANCE THAT THE OFFEROR WILL INCLUDE FAR CLAUSE 52.219-8 IN ALL SUBCONTRACTS THAT OFFER FURTHER SUBCONTRACTING OPPORTUNITIES; AND |  |  |  |  |  |
ASSURANCE THAT THE OFFEROR WILL REQUIRE ALL SUBCONTRACTORS (except SB concerns) THAT RECEIVE SUBCONTRACTS IN EXCESS OF $650,000 ($1.5 M for construction) TO ADOPT A PLAN THAT COMPLIES WITH THE REQUIREMENTS OF THE CLAUSE 52.219-9. |  |  |  |  |  |
(10) ASSURANCE THAT THE OFFEROR WILL: COOPERATE IN STUDIES OR SURVEYS; SUBMIT PERIODIC REPORTS; SUBMIT INDIVIDUAL (ISR) & SUMMARY REPORTS (SSR) USING THE eSRS; ENSURE THAT SUBCONTRACTORS WITH PLANS AGREE TO SUBMIT THE ISR/SSR USING THE eSRS; PROVIDE ITS PRIME CONTRACT NUMBER AND DUNS NUMBER AND EMAIL ADDRESS OF OFFICIALS RESPONSIBLE, ETC. |  |  |  |  |  |
(11) DESCRIPTION OF THE TYPES OF RECORDS THAT WILL BE MAINTAINED CONCERNING PROCEDURES ADOPTED TO COMPLY, AND A DESCRIPTION OF THE OFFEROR’S EFFORTS TO LOCATE VARIOUS SMALL BUSINESS CONCERNS AND AWARD SUBCONTRACTS TO THEM |  |  |  |  |  |

REMARKS. PCO/ACO COMMENTS (i.e. original contract award, first plan or first govt. contract, annual commercial update or riding previously approved plan (copy attached), option renewal, change in business size from small to large, etc.) | SBTA

REVIEWED BY Ô (Signatures and Dates) | PCO/ACO DATE: | SBTA DATE: | SBA/PCR DATE: