**DEPARTMENT OF THE INTERIOR**

**ACQUISITION SCREENING AND REVIEW FORM**

  ------------- -------------------------------- -------------- ------------
  **A.                                                          
  ACQUISITION                                                   
  PLAN:**                                                       

  **1. Date     **2. Purchasing Office &         **3a.          **3b.
  Prepared:**   Address:**                       Solicitation   Purchase
                                                 Number:**      Request
                                                                Number**

                **BUREAU OF RECLAMATION, RSC,                   
                D-7810**                                        
  ------------- -------------------------------- -------------- ------------

  ----------------------------------- ----------------- -----------------
  **4. Description of Commodity or    **4a. Product &   
  Service, & Quantity:**              Service Code:**   

                                      **4b. SIC Code:** 

                                      **4c. SB Size     
                                      Standard:**       
  ----------------------------------- ----------------- -----------------

  ------------------ -- ------------ ------- -- -------------- -------------- --------------
  **5.                  **6.         **(A)      **7.           **8.           **9. Response
  Competitive:**        Proposed     YES**      Cost/Price     Solicitation   or Bid Opening
                        Synopsis**              (Estimate)**   Date           Date
                                                               (Estimate)**   (Estimate)**

  **Noncompetitive                   **(B)                                    
  (Attach                            NO**                                     
  justification                                                               
  Unless 8(a))**                                                              

                                                                              
  ------------------ -- ------------ ------- -- -------------- -------------- --------------

  ------------------------------------ ----- ------------------- ------------ -------- ----
  **10. Proposed Method of                                                             
  Acquisition: Check One Box (a)                                                       
  through (f)**                                                                        

  **(a) Section 8(a) Program**                                                         

  **(b) Very Small Business Set-Aside        **CHECK EITHER (h)                        
  (Applicable to OM actions with an          or (I)**                                  
  estimated value of greater than                                                      
  \$2,500 but not exceeding                                                            
  \$50,000)**                                                                          

  **(c) Total Small Business                 **(h) Sealed                              
  Set-Aside**                                Bidding**                                 

  **(d) Partial Small Business               **(I) Other                               
  Set-Aside**                                Negotiated (41 USC                        
                                             253(c))**                                 

  **(e) Not Set-Aside**                                                                

  **(f) Buy Indian**                                                                   

  **11. Proposed Bidders/Source List**                                                 

  **(a) Number of Small Businesses**         **(d) Number of                           
                                             Women-Owned                               
                                             Businesses**                              

  **(b) Number of Large Businesses**         **(e) Government                          
                                             Agency/Non-Profit                         
                                             Organization**                            

  **(c) Number of Min./Disadvantaged         **SBA PRONET System                       
  Business**                                 Used**                                    

                                             **YES**                          **NO**   
  ------------------------------------ ----- ------------------- ------------ -------- ----

+------------------------------------+----+-----------------------+---+
| **12. Basis for proposed Method of |    |                       |   |
| Acquisition:**                     |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **(a) Not Set-Aside for 8(a)       |    | **(c) Partial Small   |   |
| because:**                         |    | Business Set-Aside    |   |
|                                    |    | NOT Appropriate (See  |   |
|                                    |    | FAR 19.502-3)**       |   |
+------------------------------------+----+-----------------------+---+
|                                    |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **(b) Not Set-Aside for Very Small |    | **(d) REMARKS:**      |   |
| or Small Business because:**       |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **(1) Non-Competitive**            |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **(2) Insufficient number of       |    |                       |   |
| qualified Very Small or Small      |    |                       |   |
| Businesses**                       |    |                       |   |
|                                    |    |                       |   |
| **See Block 20 for documentation   |    |                       |   |
| on Market Research procedures      |    |                       |   |
| used.**                            |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **(3) See Acquisition History      |    |                       |   |
| Below**                            |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **(4) Other (Specify)**            |    |                       |   |
+------------------------------------+----+-----------------------+---+
|                                    |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **B. PREVIOUS ACQUISITION          |    |                       |   |
| HISTORY:**                         |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **13. HAS SIMILAR ITEM/SERVICE     | ** |                       |   |
| BEEN PROCURED RECENTLY?**          | YE |                       |   |
|                                    | S: |                       |   |
|                                    | ** |                       |   |
+------------------------------------+----+-----------------------+---+
|                                    | *  |                       |   |
|                                    | *N |                       |   |
|                                    | O: |                       |   |
|                                    | ** |                       |   |
+------------------------------------+----+-----------------------+---+
| **IF YES, INDICATE METHOD OF       |    |                       |   |
| ACQUISITION AND PLACE OF           |    |                       |   |
| PERFORMANCE:**                     |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **13a. Method of Acquisition:      |    |                       |   |
| (Enter one of the following        |    |                       |   |
| Codes)**                           |    |                       |   |
|                                    |    |                       |   |
| **A. (Full and Open Competition)   |    |                       |   |
| D. (Interagency/Intra agency       |    |                       |   |
| Acquisition)**                     |    |                       |   |
|                                    |    |                       |   |
| **B. (Multiple Award Schedule) E.  |    |                       |   |
| (Small Business Set-Aside)**       |    |                       |   |
|                                    |    |                       |   |
| **C. (8(a) Award) F. (Other than   |    |                       |   |
| Full and Open Competition)**       |    |                       |   |
+------------------------------------+----+-----------------------+---+
| **13b. Place of Performance:**     |    |                       |   |
+------------------------------------+----+-----------------------+---+

  ----------------- --------------- ------------------------ -------------------
  **14. If                                                   
  competitive                                                
  indicate number                                            
  of responses                                               
  received:**                                                

  **Large**         **Small**       **Min./Disadvantaged**   **Women-Owned**

                                                             
  ----------------- --------------- ------------------------ -------------------

  ----------------- --------------- ------------------- -------------------
  **15. Date of     **16. Contract  **17. Total         **18. Name of
  Award**           Number:**       Cost/Price**        Contractor and
                                                        Address:**

                                                        
  ----------------- --------------- ------------------- -------------------

  -------------------- ----------------- ------------ ----------------- ---------------
  **19. Type of Firm                                                    
  (Check all                                                            
  applicable):**                                                        

  **Small**            **Min/Disadv.**   **Large**    **Women-Owned**   **Other
                                                                        (Specify)**

                                                                        

  **20. Complete                                                        
  blocks 20a and 20b                                                    
  for Full and Open                                                     
  Competition actions                                                   
  only.**                                                               

  **20a. Describe the                                                   
  market research                                                       
  procedures used *FAR                                                  
  10.002(b)(2)\]*.**                                                    

                                                                        

  **20b. Document the                                                   
  results of the                                                        
  market research.**                                                    

                                                                        
  -------------------- ----------------- ------------ ----------------- ---------------

  ------------------- ---------------------------- ---------- -----------------
  **21. SIGNATURE AND                                         
  DATE:**                                                     

  **Purchasing                                     **Date**   
  Agent/Contract                                              
  Specialist                                                  
  (complete if                                                
  different than the                                          
  Contracting                                                 
  Officer)**                                                  

  **Contracting                                    **Date**   
  Officer**                                                   

  **Business                                       **Date**   
  Utilization &                                               
  Development                                                 
  Specialist**                                                

  **SBA                                            **Date**   
  Representative**                                            
  ------------------- ---------------------------- ---------- -----------------

**DI-1886 (rev.
3/99)/media/pszemraj/PeterTrove/project-files/DATA/ms-word-files/big-DOC/909365.doc**