Small Business Set-Aside Clearance

**SIMPLIFIED ACQUISITIONS**

Contract/Purchase Order Number:

NAICS:

Size Standard:

+-----------------------------------------------------+-----+----+----+
| **CHECKLIST**                                       | *   | ** | *  |
|                                                     | *YE | NO | *N |
|                                                     | S** | ** | /A |
|                                                     |     |    | ** |
+-----------------------------------------------------+-----+----+----+
| **Small Business Set-Aside** -- FAR 19.501(e), USDA |     |    |    |
| DR 5090-001                                         |     |    |    |
|                                                     |     |    |    |
| If this requirement is not a mandatory source or    |     |    |    |
| FSS, has it been set-aside for small business       |     |    |    |
| concerns?                                           |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **8(a) - FAR 19.8**                                 |     |    |    |
|                                                     |     |    |    |
| Requirements reviewed for offering under 8(a)       |     |    |    |
| Program.                                            |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **HUBZone - FAR 19.1305**                           |     |    |    |
|                                                     |     |    |    |
| Requirements reviewed for HUBZone Set-Aside. For    |     |    |    |
| acquisitions exceeding the simplified acquisition   |     |    |    |
| threshold, the requirement to set aside an          |     |    |    |
| acquisition for HUBZone small business concerns     |     |    |    |
| takes priority over the requirement to set aside    |     |    |    |
| the acquisition for small business concerns (FAR    |     |    |    |
| 19.501(c)).                                         |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **SDVOSB - FAR 19.1405**                            |     |    |    |
|                                                     |     |    |    |
| Requirements reviewed for SDVOSB Set-Aside.         |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **COMPETITIVENESS DEMONSTRATION PROGRAM - FAR       |     |    |    |
| 19.10, Policy Memos 19-04 and 19-08, APD Alert      |     |    |    |
| 2008-03**                                           |     |    |    |
|                                                     |     |    |    |
| (a) **Designated Industry Group (DIGs) --**         |     |    |    |
|     [unrestricted (see (b) for                      |     |    |    |
|     exception)]{.underline} competition for:        |     |    |    |
|     Construction (NAICS 236, 237 and 238); A-E      |     |    |    |
|     Services; Refuse systems and related services   |     |    |    |
|     and; landscaping and pest control services.     |     |    |    |
|                                                     |     |    |    |
| (b) **Emerging Small Business Set-Aside --**        |     |    |    |
|     applies to DIGs:                                |     |    |    |
|                                                     |     |    |    |
| ```{=html}                                          |     |    |    |
| <!-- -->                                            |     |    |    |
| ```                                                 |     |    |    |
| (1) \<\$30,000 for construction; refuse systems and |     |    |    |
|     related services and; landscaping and pest      |     |    |    |
|     control services.                               |     |    |    |
|                                                     |     |    |    |
| (2) \<\$50,000 for A-E Services                     |     |    |    |
|                                                     |     |    |    |
| ```{=html}                                          |     |    |    |
| <!-- -->                                            |     |    |    |
| ```                                                 |     |    |    |
| (c) **Targeted Industry Categories (TICs) --**      |     |    |    |
|     Reserved for small business with priority       |     |    |    |
|     consideration for 8(a), HubZone, and SDVOSB     |     |    |    |
|     set-asides: Radio TV Equipment Except Airborne; |     |    |    |
|     Chemical Products; ADP Central Processing       |     |    |    |
|     Units-Digital; Bags and Sacks; Outerwear for    |     |    |    |
|     Men; Maintenance and Repairs, ADP Equipment;    |     |    |    |
|     Installation of ADP Equipment; Other            |     |    |    |
|     Photo/Mapping Printing/Services;                |     |    |    |
|     Vocational/Technical Training and; Leasing      |     |    |    |
|     Special Industry Machinery.                     |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **AD-1205**                                         |     |    |    |
|                                                     |     |    |    |
| If the requirement is not set-aside, has an         |     |    |    |
| AD-1205, USDA Small Business Program -- Procurement |     |    |    |
| Request Review, been submitted for all unrestricted |     |    |    |
| procurements over the simplified acquisition        |     |    |    |
| threshold not already set-aside or reserved for     |     |    |    |
| small business participation?                       |     |    |    |
+-----------------------------------------------------+-----+----+----+

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contracting Officer/Contract Specialist/Purchasing Agent & Date

Small Business Set-Aside

**MANAGEMENT & OVERSIGHT**

+-----------------------------------------------------+-----+----+----+
| **CHECKLIST**                                       | *   | ** | *  |
|                                                     | *YE | NO | *N |
|                                                     | S** | ** | /A |
|                                                     |     |    | ** |
+-----------------------------------------------------+-----+----+----+
| **Small Business Set-Aside** **-- Policy Memo       |     |    |    |
| 19-07**                                             |     |    |    |
|                                                     |     |    |    |
| Has an AD-1205, USDA Small Business Program --      |     |    |    |
| Procurement Request Review, been submitted for all  |     |    |    |
| unrestricted procurements over the simplified       |     |    |    |
| acquisition threshold not already set-aside or      |     |    |    |
| reserved for small business participation?          |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **8(a) - FAR 19.8**                                 |     |    |    |
|                                                     |     |    |    |
| Requirements reviewed for offering under 8(a)       |     |    |    |
| Program?                                            |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **HUBZone - FAR 19.1305**                           |     |    |    |
|                                                     |     |    |    |
| Requirements reviewed for HUBZone Set-Aside?        |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **SDVOSB - FAR 19.1405**                            |     |    |    |
|                                                     |     |    |    |
| Requirements reviewed for SDVOSB Set-Aside?         |     |    |    |
+-----------------------------------------------------+-----+----+----+
| **COMPETITIVENESS DEMONSTRATION PROGRAM - FAR       |     |    |    |
| 19.10, Policy Memos 19-04 and 19-08, APD Alert      |     |    |    |
| 2008-03**                                           |     |    |    |
|                                                     |     |    |    |
| (a) **Designated Industry Group (DIGs) --**         |     |    |    |
|     [unrestricted (see (b) for                      |     |    |    |
|     exception)]{.underline} competition for:        |     |    |    |
|     Construction (NAICS 236, 237 and 238); A-E      |     |    |    |
|     Services; Refuse systems and related services   |     |    |    |
|     and; landscaping and pest control services.     |     |    |    |
|                                                     |     |    |    |
| (b) **Emerging Small Business Set-Aside --**        |     |    |    |
|     applies to DIGs:                                |     |    |    |
|                                                     |     |    |    |
| ```{=html}                                          |     |    |    |
| <!-- -->                                            |     |    |    |
| ```                                                 |     |    |    |
| (3) \<\$30,000 for construction; refuse systems and |     |    |    |
|     related services and; landscaping and pest      |     |    |    |
|     control services.                               |     |    |    |
|                                                     |     |    |    |
| (4) \<\$50,000 for A-E Services                     |     |    |    |
|                                                     |     |    |    |
| ```{=html}                                          |     |    |    |
| <!-- -->                                            |     |    |    |
| ```                                                 |     |    |    |
| (c) **Targeted Industry Categories (TICs) --**      |     |    |    |
|     Reserved for small business with priority       |     |    |    |
|     consideration for 8(a), HubZone, and SDVOSB     |     |    |    |
|     set-asides: Radio TV Equipment Except Airborne; |     |    |    |
|     Chemical Products; ADP Central Processing       |     |    |    |
|     Units-Digital; Bags and Sacks; Outerwear for    |     |    |    |
|     Men; Maintenance and Repairs, ADP Equipment;    |     |    |    |
|     Installation of ADP Equipment; Other            |     |    |    |
|     Photo/Mapping Printing/Services;                |     |    |    |
|     Vocational/Technical Training and ; Leasing     |     |    |    |
|     Special Industry Machinery. Is the Area office  |     |    |    |
|     aware of and complying with small business      |     |    |    |
|     set-asides for their requirements?              |     |    |    |
+-----------------------------------------------------+-----+----+----+