Doe Form 4220.2 - Small Business Review
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3DOE F 4220.2
Office of Small and Disadvantaged Business Utilization
(01/2014)
Small Business Review
OSDBU Control Number: _______________________________________Date Received: ______________________________
A. Project Information
1. Requisition Number: ________________________
2. Acquisition Office and Program Element:
Acquisition Instrument Proposed/Contract Type:
[ ] Contract No (Mod): ______________________
CO/CS Name:
[ ] Departmental IDIQ No: ___________________
[ ] GSA Schedule: _________________________
[ ] GWAC Contract: ________________________
Contact Information (Telephone and E-mail):
[ ] DOE BPA:_____________________________
3. Description of services or supplies:
4. Total Estimated Value (Including Options): $ ______________________________________
5.a. Period of Performance (including Options) or Delivery Date: ___________________________________________________.
5.b. Estimated RFP/RFQ Issuing Date.____________________________
_________________
B. Project Considerations
6. NAICS Code(s): __________________________
7. [ ] New Requirement [ ] Recompetition
Description: ___________________________
Acquisition History:
Size Standard: ______________________
Previous Contract Number: ______________ Award Date: __________
8. Bundling Determination:
Ultimate Contract Value: _______________________________
Contractor Name: ___________________________________________
[ ] N/A: Below established threshold: FAR 7.104(d)(2)
Business Size: _____________________________
Yes No
Comments: ________________________________________________
[ ] [ ] Is the requirement bundled?
__________________________________________________________
If yes, attach supporting documentation
9. Efforts made to locate sources within the last 12
10. Proposed Acquisition Strategy/Plan
months:
[
] Partial Set-Aside (include dollar value and Percentages):
YES NO
[
] Small Business ___________________________
[ ]
[ ]
Review of Prior or Similar Acquisitions
[
] 8(a) Program
___________________________
[ ]
[ ]
Sources Sought Notice (Copy
[
] HUBZone
___________________________
Attached)
[
] SDVOSB
___________________________
[ ]
[ ]
Market Survey (Copy Attached)
[
] WOSB
___________________________
[ ]
[ ]
Consult DOE Small Business Specialist
[
] Sole/Limited Sources (attach justification)____________
[ ]
[ ]
System for Award Management (SAM)
[
] Directed by Statute (Provide Citation):______________
[ ]
[ ]
Other: _________________________
[
] No Reasonable expectation of obtaining 2 or more SB offers.
[
] Other (explain): _________________________________
11. Synopsis:
12. Other Considerations that apply to the Solicitation:
Yes No
[ ] Yes (FEDBIZOPPS)
[
] [
] Subcontracting Plan
(if no, see instructions)
[ ] No. Per FAR 5.202 ______
[ ] Other:_________________
Other: ____________________________________________________________
C. Project Review & Approval
13. Cognizant Contracting Official:
14. Small Business Program Manager:
15. SBA Procurement Center Representative:
[ ] Concur
[ ] Non-concurrence:
[ ] Concur
[ ] Non-concurrence:
_ _
___ ___
_ __
______
___
__
__
Signature
Date
Signature
Date
Signature
Date
DOE Form 4220.2 (Revised January 2014)
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