Contract/Solicitation Number:
Company Name:
Division:
Location:
(Circle One)
1. Has the PCO met the requirements of FAR 19.705 and DFARS 219.705? Yes No

2. Does a Master Plan (MP) apply? (FAR 52.219-9(f) Yes No
Complete the following if answer was "Yes" Yes No

a. Effective Period is:
b. Respond to Blocks 1-7 and others not addressed in Master Plan
c. Is evidence of ACO approval provided? Yes No
d. Is ACO approval on file in SB office? Yes No

3. Are separate percentage goals proposed? (See FAR 52.219-9(d)(1) Yes No

Complete the following:

a. Small Business: %

(1) Is approval required? Yes No
(2) Is approval shown? Yes No

b. Small Disadvantaged Business: % Yes No
(1) Is approval required? Yes No
(2) Is approval shown? Yes No

(DFARs 219.705-4 requires that Zero (0) Small Business goals be challenged and that SDB goals of less than 5% be approved two levels above the PCO).

c. Is anticipated use of HBCUs and MIs in the SDB goal addressed? Yes No
(DFARs 219.704(a)(l))

4. Are goals based on total planned subcontracting dollars? Yes No
(FAR 52.219-9(d)(2))
Complete the following:

a. Total Subcontract Dollars: $
b. SB Subcontract Dollars: $ %

c. SDB Subcontract Dollars $ %
5. Does plan include description of principal types of supplies and services Yes No
to be subcontracted and to whom? (FAR 52.219-9(d)(3))

Circle the appropriate letter(s):
a. Small Business
b. Small Disadvantaged Business
c. Other Business Categories

6. Is method of developing proposed subcontracting goals stated? Yes No
(FAR 52.219-9(d)(4))

7. Is method used to identify small and disadvantaged business stated? Yes No
(FAR 52.219-9(d)(5))

Circle the appropriate letter(s):

a. SBA PASS is utilized
b. National Minority Purchasing Council is utilized
c. US Department of Commerce services are utilized
d. Other sources are utilized.

8. Is a proportionate share of indirect or overhead cost included (optional) and, Yes No
if so, a description of the method to be used? (FAR 52.219-9(d)(6))

If so, for which goals (circle appropriate letter(s)):

a. Small Business
b. Small Disadvantaged Business

9. Is the Subcontract Plan Administrator identified and a description Yes No
of his/her duties included? (FAR 52.219-9(d)(7))

Complete the following:

a. Subcontract Plan Administrator
b. Title

10. Does plan describe the efforts that the contractor plans to Yes No
undertake which will:

a. Assure SB/SDB firms have equitable Yes No
opportunity to compete for subcontracting?
(FAR 52.219-9(d)(8))

b. Provide technical assistance and restrict competition to SDB firms? Yes No (DFARs 219.705-4)

11. Is program flow down clearly and adequately covered? Yes No
(FAR 52.219-9(d)(9))

Complete:

a. "Utilization Clause" addressed? Yes No
(FAR 52.219-8)

b. Will subcontractors (other than SB/SDBs be required to adopt Yes No
a plan in consonance with FAR 52.219-9 or the Alternate I clause
(for sealed bidding)?

12. Does plan contain assurances that contractor will: Yes No
(DFARS 52.219-9(d)(10)(i), (ii), (iii), (iv))

a. Submit periodic reports? Yes No

b. Cooperate in any studies or surveys as may be required by the Yes No
contracting agency or SBA to determine compliance with the plan?

c. Submit required Standard Forms 294 and 295? Yes No

13. Does plan contain recitation of types of records that will be maintained Yes No
to demonstrate compliance? (FAR 52.219-9(d)(11)(i), (ii), (iii), (iv), and (v))

Minimum requirements are met:

a. SB/SDB source lists Yes No
b. Organizations contacted Yes No
c. Records (contract-by-contract) on subcontract solicitations Yes No

(1) SB concerns solicited; if not, why not? Yes No
(2) SDB concerns solicited; if not, why not? Yes No
(3) Reason award not made to a Small Business concern Yes No

d. Contacts with trade associations Yes No
e. Contacts with business development organizations Yes No
f. Attendance at conferences and trade fairs Yes No
g. Internal workshops and training programs Yes No
h. Monitoring efforts to evaluate compliance Yes No

14. Do records exist to support (contract-by- contract) award data to include Yes No
name, address, and size status of subcontractors or indication that
company has annual plans in lieu thereof? (FAR 52.219-9(d)(11)(vi))

15. Does plan demonstrate and document efforts to assist and facilitate Yes No subcontract participation (FAR 52.219-9(e)(1))

16. Is adequate and timely consideration of SB/SDB potential in Yes No
"make-or-buy" decisions evident? (FAR 52.219-9(e)(2))

17. Does plan demonstrate and document efforts to counsel and Yes No
discuss subcontracting opportunities with SB/SDB
concerns? (FAR 52.219-9(e)(4))

18. Are subcontractors provided a notice (similar to that in solicitation Yes No
provision FAR 52.219-1) concerning the penalties for misrepresenting
their size status as SB/SDB in order to obtain a subcontract
on this requirement? (FAR 52.219-9(e)(4))

19. In continuing management interest and involvement in support Yes No
of Public Law 95-507 clearly demonstrated and documented?

20. Company-wide policy statements, written procedures, and work instructions:

a. Exist? Yes No
b. Are adequate and concise Yes No c. Are furnished with the plan? Yes No

21. Does plan, as submitted, clearly demonstrate a program to provide Yes No
maximum practicable opportunity for SB/SDB participation?

22. Is a subcontracting incentive clause appropriate? Yes No
(DFARs 219.708(c)(1)(2)

The above checklist is for informational purposes for documenting the Procuring Contracting Officer's (PCO's) review of the adequacy of the contractor's proposed subcontracting plan.

____________________________________
Buyer

___________________________________
Contracting Officer