Fillable Dd Form 2579 Small Business Coordination Record printable pdf download

Dd Form 2579 Small Business Coordination Record

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REPORT CONTROL SYMBOL

DD-AT&L(AR)1862

SMALL BUSINESS COORDINATION RECORD

1. CONTROL NO.

2. PURCHASE REQUEST NO./

3. TOTAL ESTIMATED VALUE

4. SOLICITATION NO./CONTRACT

(Optional)

REQUISITION NO.

MODIFICATION NO.

(Including options)

5. BUYER

a. NAME (Last, First, Middle Initial)

b. OFFICE SYMBOL

c. TELEPHONE (Include Area Code)

6. ITEM DESCRIPTION

6a. FEDERAL SUPPLY CLASS/SERVICE

(Including quantity)

(FSC/SVC) CODE

7. TYPE OF COORDINATION

8. SMALL BUSINESS SIZE STANDARD

(X one)

a. NORTH AMERICAN INDUSTRY CLASSIFICATION

b. NO. OF EMPLOYEES

c. DOLLARS

INITIAL CONTACT

SYSTEM (NAICS) CODE

MODIFICATION

WITHDRAWAL

9. RECOMMENDATION

10. ACQUISITION HISTORY

(X as applicable)

(X one)

(If all recommendations are "No," explain in Remarks.)

YES NO

a. FIRST TIME BUY

a. SECTION 8(a) (X one)

b. PREVIOUS ACQUISITION (X all that apply)

(1) COMPETITIVE

(2) SOLE SOURCE

(1) SECTION 8(a)

b. SMALL DISADVANTAGED BUSINESS (SDB) SET-ASIDE

(2) SDB SET-ASIDE

c. HISTORICALLY BLACK COLLEGES AND UNIVERSITIES/

(3) HBCU/MI SET-ASIDE

MINORITY INSTITUTIONS (HBCU/MI) SET-ASIDE

(List percentage)

(4) SB SET-ASIDE

d. SMALL BUSINESS (SB) SET-ASIDE

(5) OTHER (Specify)

(List percentage)

e. EMERGING SMALL BUSINESS SET-ASIDE

(6) TWO OR MORE RESPONSIVE SB OFFERS ON PRIOR ACQUISITION

f. EVALUATION PREFERENCE FOR SDBs

(7) ONE OR MORE RESPONSIVE SDB OFFER(S) WITHIN 10% OF

AWARD PRICE OF PRIOR ACQUISITION

g. HUBZONE SET-ASIDE

h. HUBZONE SOLE SOURCE

(8) WOMAN OWNED SB

i. HUBZONE PRICE EVALUATION PREFERENCE

(9) SERVICE-DISABLED VETERAN SB

11. SB PROGRESS PAYMENTS

12. SUBCONTRACTING PLAN

REQUIRED

(X one)

13. SYNOPSIS REQUIRED

(X one) (If "No," cite FAR 5.202 exception)

YES

14. REMARKS

16. LOCAL USE

15. REVIEWED BY SMALL BUSINESS ADMINISTRATION (SBA)

REPRESENTATIVE

a. NAME (Last, First, Middle Initial)

b. SIGNATURE

c. DATE SIGNED

(YYYYMMDD)

17. CONTRACTING OFFICER

18. SMALL BUSINESS SPECIALIST

(X one)

CONCURS

REJECTS

CONCURS

APPEALS

a. RECOMMENDATIONS (Document rejections on reverse side)

NOTE: Any change in the acquisition plan this coordination record

describes will require return for re-evaluation by the SB specialist.

b. NAME (Last, First, Middle Initial)

a. NAME (Last, First, Middle Initial)

c. SIGNATURE

d. DATE SIGNED

b. SIGNATURE

c. DATE SIGNED

(YYYYMMDD)

DD FORM 2579, DEC 2000

PREVIOUS EDITION IS OBSOLETE.

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Dd Form 2579 Small Business Coordination Record

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