+------------------------------------------------+---------------------+
| #  Data Deliverable Requirement Description    | 1.  **Subcontract   |
|                                                |     No:      **     |
| ##  *Lower Tier Supp                           |                     |
| lier Information - New Mexico Small Business*  | **2. DD No:      ** |
|                                                |                     |
| **Remarks:**                                   | 2.                  |
|                                                |                     |
|                                                | **3. Date/Revision  |
|                                                | Date:      **       |
| **[Preparation Information]{.underline}:** As  |                     |
| part of its small business semi-annual         | **4.                |
| reporting requirements, the Subcontractor is   | Au                  |
| required to provide small business             | thority/Requirement |
| supplemental performance information specific  | Cite:      **       |
| to New Mexico and Northern New Mexico small    |                     |
| business firms.                                | 5.  **Originator:   |
|                                                |     SBO Office**    |
| Page 2 and 3 of this Data Deliverable          |                     |
| Requirement Description sets forth the format  | 6\. Media: Hard     |
| that the Subcontractor will be required to use | copy and Email Word |
| in submitting small business information.      | Attachment          |
|                                                |                     |
| This supplemental information shall be         | **7. Frequency of   |
| provided at the time the Subcontractor submits | Submission: Once**  |
| small business performance information (SF     |                     |
| 294). The SF 294 shall include goal and dollar | **8. Controlled     |
| information otherwise broken out for New       | Document:**         |
| Mexico and Northern New Mexico small business  |                     |
| firms.                                         | **Yes \_\_\_\_\_\_  |
|                                                | No                  |
|                                                | [\_\_X              |
|                                                | \_\_]{.underline}** |
|                                                |                     |
|                                                | **9. Approval       |
|                                                | Required:**         |
|                                                |                     |
|                                                | **Yes               |
|                                                | [\_\_\              |
|                                                | _X\_\_]{.underline} |
|                                                | No \_\_\_\_\_\_**   |
|                                                |                     |
|                                                | **10. Distribution  |
|                                                | and Number of       |
|                                                | Copies:**           |
|                                                |                     |
|                                                | **Contract          |
|                                                | Administrator - 1** |
|                                                |                     |
|                                                | **SBO - 1**         |
|                                                |                     |
|                                                | 11. **Deliverable   |
|                                                |     Submission      |
|                                                |     Date:      **   |
|                                                |                     |
|                                                | ##### I             |
|                                                | nitial Submittal: C |
|                                                | ommensurate with Sm |
|                                                | all Business Plan.  |
|                                                |                     |
|                                                | ####                |
|                                                | # Report submission |
|                                                | s - March 30^th^ an |
|                                                | d September 30^th^. |
+------------------------------------------------+---------------------+

Page 1 of 3

Supplemental Subcontracting Report

*Lower Tier Supplier Information*

New Mexico and Northern New Mexico Small Business

The data reported on the form set forth below shall include small
business performance activity in New Mexico and Northern New Mexico
*only*. Data provided on this form shall be inclusive of the information
provided on SF 294, *[Subcontracting Report for Individual
Contracts.]{.underline}* Information shall be reported by March 30^th^
and September 30th of each subcontract year. Refer to web-site
(sbo.lanl.gov), or call the Small Business Office at 505/667-4410, if
you need assistance in preparing this document or contacting businesses
in these areas.

[Completion Instructions:]{.underline}

Column: A and B - Enter small business goal information for the
corresponding small business categories (1 through 9).

Column: C and D - Enter actual cumulative (total) subcontract values for
each of the corresponding small business categories.

Column: E - Enter actual payment (in whole dollars) for corresponding
small business categories.

+--------------------------------+-------+----+-------+----+--------+
| ### New Mexi                   |       |    |       |    |        |
| co Small Business Performance  |       |    |       |    |        |
|                                |       |    |       |    |        |
| ### (EXCLUD                    |       |    |       |    |        |
| ING Northern New Mexico Firms) |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| # **Small Business Category**  | ## Cu |    | #     |    | ### Pa |
|                                | rrent |    | ## Ac |    | yments |
|                                |  Goal |    | tual  |    |        |
|                                |       |    | Cumul |    |        |
|                                |       |    | ative |    |        |
+--------------------------------+-------+----+-------+----+--------+
| #                              | *     | ## | *     | ** | **E.** |
|                                | *A.** |  B | *C.** | D. |        |
|                                |       | .  |       | ** | *      |
|                                | **    |    | **    |    | *Total |
|                                | Whole | ## | Whole | *  | Dol    |
|                                | Doll  |  P | doll  | *P | lars** |
|                                | ars** | er | ars** | er |        |
|                                |       | ce |       | ce |        |
|                                |       | nt |       | nt |        |
|                                |       |    |       | ** |        |
+--------------------------------+-------+----+-------+----+--------+
| # 1. Small Business Concerns   |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| #                              |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 2\. Large Business Concerns    |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 3\. Total (Large & Small)      |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 4\. Small Disadvantaged        |       |    |       |    |        |
| Business                       |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 5\. Woman-Owned Small Business |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 6\. HUBZone Small Business     |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 7\. Veteran-Owned Small        |       |    |       |    |        |
| Business                       |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 8\. Service-Disabled Veteran   |       |    |       |    |        |
| Owned Small Business           |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 9\. 8(a)                       |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 10**. Total**                  |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+

**[Completion Instructions:]{.underline}** Provide the same type of
information as set forth in the completion instructions at the top of
this page

**EXCEPT** that the data will be provided for Northern New Mexico Small
Business **ONLY**.

+--------------------------------+-------+----+-------+----+--------+
| ### Northern New Mexi          |       |    |       |    |        |
| co Small Business Performance  |       |    |       |    |        |
|                                |       |    |       |    |        |
| ### (Nor                       |       |    |       |    |        |
| thern New Mexico Firms *ONLY*) |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| # **Small Business Category**  | ## Cu |    | #     |    | ### Pa |
|                                | rrent |    | ## Ac |    | yments |
|                                |  Goal |    | tual  |    |        |
|                                |       |    | Cumul |    |        |
|                                |       |    | ative |    |        |
+--------------------------------+-------+----+-------+----+--------+
| #                              | *     | ## | *     | ** | **E.** |
|                                | *A.** |  B | *C.** | D. |        |
|                                |       | .  |       | ** | *      |
|                                | **    |    | **    |    | *Total |
|                                | Whole | ## | Whole | *  | Dol    |
|                                | Doll  |  P | doll  | *P | lars** |
|                                | ars** | er | ars** | er |        |
|                                |       | ce |       | ce |        |
|                                |       | nt |       | nt |        |
|                                |       |    |       | ** |        |
+--------------------------------+-------+----+-------+----+--------+
| # 1. Small Business Concerns   |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| #                              |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 2\. Large Business Concerns    |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 3\. Total (Large & Small)      |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 4\. Small Disadvantaged        |       |    |       |    |        |
| Business                       |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 5\. Woman-Owned Small Business |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 6\. HUBZone Small Business     |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 7\. Veteran-Owned Small        |       |    |       |    |        |
| Business                       |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 8\. Service-Disabled Veteran   |       |    |       |    |        |
| Owned Small Business           |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 9\. 8(a)                       |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+
| 10**. Total**                  |       |    |       |    |        |
|                                |       |    |       |    |        |
|                                |       |    |       |    |        |
+--------------------------------+-------+----+-------+----+--------+

**Page 2 of 3**

**[Completion Instructions]{.underline}:** Provide the information set
forth below for each lower tier subcontract. Note that the information

shall be compiled and separately reported for New Mexico and Northern
New Mexico firms.

+----------+------------+------+-----+-----+------+---------+-------+
| ######## |            |      |     |     |      |         |       |
| # New Me |            |      |     |     |      |         |       |
| xico Sma |            |      |     |     |      |         |       |
| ll Busin |            |      |     |     |      |         |       |
| ess Perf |            |      |     |     |      |         |       |
| ormance  |            |      |     |     |      |         |       |
| *[(Exclu |            |      |     |     |      |         |       |
| ding Nor |            |      |     |     |      |         |       |
| thern Ne |            |      |     |     |      |         |       |
| w Mexico |            |      |     |     |      |         |       |
| )]{.unde |            |      |     |     |      |         |       |
| rline}*  |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
| *        | *          | **SB | **C | *   |      |         |       |
| *Company | *Address** | Ca   | ont | *Po |      |         |       |
| Name**   |            | tego | rac | int |      |         |       |
|          |            | ry** | t** | o   |      |         |       |
|          |            |      |     | f** |      |         |       |
|          |            |      | **V |     |      |         |       |
|          |            |      | alu | **  |      |         |       |
|          |            |      | e** | Con |      |         |       |
|          |            |      |     | tac |      |         |       |
|          |            |      |     | t** |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
| **       |            |      |     |     |      |         |       |
| Northern |            |      |     |     |      |         |       |
| New      |            |      |     |     |      |         |       |
| Mexico   |            |      |     |     |      |         |       |
| Small    |            |      |     |     |      |         |       |
| Business |            |      |     |     |      |         |       |
| Per      |            |      |     |     |      |         |       |
| formance |            |      |     |     |      |         |       |
| *[ONLY   |            |      |     |     |      |         |       |
| ]{.under |            |      |     |     |      |         |       |
| line}*** |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
| *        | *          | **SB | **C | *   |      |         |       |
| *Company | *Address** | Ca   | ont | *Po |      |         |       |
| Name**   |            | tego | rac | int |      |         |       |
|          |            | ry** | t** | o   |      |         |       |
|          |            |      |     | f** |      |         |       |
|          |            |      | **V |     |      |         |       |
|          |            |      | alu | **  |      |         |       |
|          |            |      | e** | Con |      |         |       |
|          |            |      |     | tac |      |         |       |
|          |            |      |     | t** |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+
|          |            |      |     |     |      |         |       |
|          |            |      |     |     |      |         |       |
+----------+------------+------+-----+-----+------+---------+-------+

######### Page 3 of 3