Dhs Form 700-22 - Small Business Review Form - Department Of Homeland Security

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DEPARTMENT OF HOMELAND SECURITY
SMALL BUSINESS REVIEW FORM
Items (1-8) Request - Completed by the Contracting Officer in consultation with the Requesting Office
(1) Requisitioner Name/Telephone Number
(2) Office/Organization
(3) Requisition Number
(4) Contract Specialist Name/Telephone Number
(5) Contracting Officer Name/Telephone Number
(6) Description of Product or Service
(7) Estimated dollar value: Base Period: $___________________________ Total Estimated Value Incl.Options $ _________________
(8) Period of Performance: Base Period FROM: ________ TO: _________; Option Periods _______ FROM: _______TO: _______
Items (9-19) - Strategy; to include Proposed Procurement Method - Completed by the Contracting Officer
(9) NAICS Code
(10) Small Business Size Standard
(11) Synopsis Requirement
Employees
YES
Avg. annual receipts
NO, exceptions [FAR 5.202(a)]
(12) Prior Procurement History:
New Requirement
YES
NO
(If no, consult with your SBS to complete Item(12))
Contract/Delivery or Task Order Number
Period of Performance
Contractor Name & Address
Total Price:
Contractor Size/Preference Status:
No. of Offerors:
LB
SB
HUBZ.
SDB
8(a)
WOB
SDVO
VET
Remarks: ____________________________________________________________________________________________________
Items (13-19) - Proposed Procurement Method - Completed by the Contracting Officer
If planning an open market procurement of $100,000 or more, complete Items (13-17). If action is $2,000,000 or more and the use of
Pre-existing Contract Vehicle (such as MAS (FSS)-GSA, MAC, GWAC, DHS-wide contract, multiple award contract, BPA) is planned,
complete Items (18-19) for Substantial Bundling Review. Consult your Small Business Specialist for completion of this section.
* * * * * * * *
FOR OPEN MARKET PROCUREMENT OF $100,000 OR MORE * * * *
* * * *
(13) First Consideration: Consider one of the socioeconomic initiatives.
Competitive
Sole Source
Other
8(a)
8(a)
Multiple Award (any socio-economic program + LB)
HUBZone Set-Aside
HUBZone
SDVOSB Set-Aside
SDVOSB
Total SB Set-Aside
Partial SB Set-Aside
(14) Second Consideration: If first consideration has been ruled out based on market research, then turn to full and open competition.
Where an other than small business concern serves as the prime contractor, small business participation will be critical through
subcontracting and the DHS Mentor Protégé Program. If no subcontracting opportunities exist, attach the associated documentation.
Competitive
Sole Source
Unrestricted (Full and Open)
Other (Attach Justification and Approval (J&A))
Multiple Award (LB)
(15)
Subcontracting Plan Discussion with SBS
Mentor-Protégé Program Discussion with SBS
DHS Form 700-22 (Rev. 10/05)
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