**VOLPE NATIONAL TRANSPORTATION SYSTEMS CENTER**

**ACQUISITION MANAGEMENT DIVISION**

# SMALL BUSINESS COORDINATION RECORD

\[ INSTRUCTION: A completed form is required for ALL procurement
requests valued over \$100,000, excluding within-scope modifications and
task/delivery orders issued under Volpe Center ID/IQ Contract, and
Interagency Agreements. For purchases processed under SAP, only PRs
valued over \$25,000 that are not identified as Set Aside for the Small
Business Programs require the Small Business Specialist and SBA/PCR
signatures.\]

+-----------------------------+----+-----------------------------------+
| 1\. SUBMITTEDTO: Small      |    | 2\. INITIATED BY: DOT/Volpe       |
| Business Administration     |    | Center/DTS-853                    |
|                             |    |                                   |
| ATTN: Procurement Center    |    | Volpe Center Small Business       |
| Representative (PCR)        |    | Specialist                        |
+-----------------------------+----+-----------------------------------+
| 3\. PROCUREMENT REQUEST     |    | 4\. TOTAL ESTIMATED VALUE:        |
| NUMBER:                     |    |                                   |
+-----------------------------+----+-----------------------------------+
| 5a. BUYER:                  |    | 5b. TELEPHONE:                    |
+-----------------------------+----+-----------------------------------+
| 6\. SMALL BUSINESS SIZE     |    |                                   |
| STANDARD: a. NORTH AMERICAN |    |                                   |
| INDUSTRY CLASSIFICATION     |    |                                   |
| SYSTEM (NAICS)              |    |                                   |
|                             |    |                                   |
| CODE:                       |    |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\     |    |                                   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |    |                                   |
| b. Number of Employees      |    |                                   |
| \_\_\_\_\_\_\_\_\_\_ c.     |    |                                   |
| Dollars                     |    |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_    |    |                                   |
+-----------------------------+----+-----------------------------------+
| 7\. DESCRIPTION OF ITEM(S)  |    |                                   |
| OR SERVICE(S):              |    |                                   |
+-----------------------------+----+-----------------------------------+
| 8\. SET ASIDE               | 9  |                                   |
| RECOMMENDATION:             | \. |                                   |
|                             | N  |                                   |
| \_\_\_\_\_\_ Total          | ON |                                   |
| \_\_\_\_\_ Partial          | S  |                                   |
|                             | ET |                                   |
| \_\_\_\_\_\_ Competitive    | AS |                                   |
| \_\_\_\_\_ Sole Source      | ID |                                   |
|                             | E: |                                   |
| \_\_\_\_\_\_ 8(a)           | Re |                                   |
|                             | as |                                   |
| \_\_\_\_\_\_ Small          | on |                                   |
| Disadvantaged Business      | f  |                                   |
| (SDB)                       | or |                                   |
|                             | n  |                                   |
| \_\_\_\_\_\_ Historically   | ot |                                   |
| Black Colleges and          | ma |                                   |
|                             | ki |                                   |
| Universities/Minority       | ng |                                   |
| Institutions                | a  |                                   |
|                             | S  |                                   |
| \_\_\_\_\_\_ Small Business | et |                                   |
| (SB); Non-Manufacturer      | As |                                   |
|                             | id |                                   |
| Rule                        | e: |                                   |
| Waived\_\_\_\_\_\_\_\_\_\_  |    |                                   |
|                             | \_ |                                   |
| \_\_\_\_\_\_ Targeted       | \_ |                                   |
| Industry under Small        | \_ |                                   |
|                             | \_ |                                   |
| Business Competitiveness    | A  |                                   |
|                             | wa |                                   |
| Demonstration Program       | rd |                                   |
|                             | is |                                   |
| \_\_\_\_\_\_ Emerging Small | b  |                                   |
| Business                    | ei |                                   |
|                             | ng |                                   |
| \_\_\_\_\_\_ Evaluation     | is |                                   |
| Preference for SDBs         | su |                                   |
|                             | ed |                                   |
| \_\_\_\_\_\_ Very Small     | pu |                                   |
| Business -- SBA Designated  | rs |                                   |
|                             | ua |                                   |
| Di                          | nt |                                   |
| strict:\_\_\_\_\_\_\_\_\_\_ | to |                                   |
|                             | t  |                                   |
| \_\_\_\_\_\_ HUBZone        | he |                                   |
|                             | S  |                                   |
| \_\_\_\_\_\_ HUBZone Price  | ma |                                   |
| Evaluation Preference       | ll |                                   |
|                             | Bu |                                   |
|                             | si |                                   |
|                             | ne |                                   |
|                             | ss |                                   |
|                             | C  |                                   |
|                             | om |                                   |
|                             | pe |                                   |
|                             | ti |                                   |
|                             | ti |                                   |
|                             | ve |                                   |
|                             | D  |                                   |
|                             | em |                                   |
|                             | on |                                   |
|                             | st |                                   |
|                             | ra |                                   |
|                             | ti |                                   |
|                             | on |                                   |
|                             | P  |                                   |
|                             | ro |                                   |
|                             | gr |                                   |
|                             | am |                                   |
|                             | (  |                                   |
|                             | De |                                   |
|                             | si |                                   |
|                             | gn |                                   |
|                             | at |                                   |
|                             | ed |                                   |
|                             | In |                                   |
|                             | du |                                   |
|                             | st |                                   |
|                             | ry |                                   |
|                             | G  |                                   |
|                             | ro |                                   |
|                             | up |                                   |
|                             | (D |                                   |
|                             | IG |                                   |
|                             | )) |                                   |
|                             |    |                                   |
|                             | \  |                                   |
|                             | _\ |                                   |
|                             | _\ |                                   |
|                             | _\ |                                   |
|                             | _O |                                   |
|                             | th |                                   |
|                             | er |                                   |
+-----------------------------+----+-----------------------------------+
| 10\.                        |    |                                   |
|                             |    |                                   |
| \_\_\_\_\_\_ Subcontracting |    |                                   |
| Plan Required               |    |                                   |
|                             |    |                                   |
| \_\_\_\_\_\_ Synopsis       |    |                                   |
| Required If *No,* cite FAR  |    |                                   |
| 5.202 exception             |    |                                   |
| \_\_\_\_\_\_                |    |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\ |    |                                   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |    |                                   |
|                             |    |                                   |
| \_\_\_\_\_\_ Contract       |    |                                   |
| Bundling Impact Considered  |    |                                   |
+-----------------------------+----+-----------------------------------+
| 11\. REMARKS                |    |                                   |
+-----------------------------+----+-----------------------------------+
| 12\. DOT/VOLPE CENTER       |    | 13\. REVIEWED BY SBA/PCR          |
|                             |    |                                   |
| SB Specialist Date          |    | \_\_\_\_\_ Concur \_\_\_\_\_\_    |
|                             |    | Reject                            |
|                             |    |                                   |
|                             |    | SBA Representative Date           |
+-----------------------------+----+-----------------------------------+
| 14\. CONTRACTING OFFICER    |    | NOTE: Any change in the           |
|                             |    | acquisition plan this             |
| \_\_\_\_\_ Concur           |    | coordination record describes     |
| \_\_\_\_\_ Reject           |    | will require return for           |
|                             |    | re-evaluation by the SB           |
| Contracting Officer Date:   |    | specialist. Document any changes  |
|                             |    | in the Remarks Block 11.          |
+-----------------------------+----+-----------------------------------+

DTS85F.18 (12/03)