Revised 04/25/06

Department of Defense Mentor-Protégé Agreement

MENTOR-PROTÉGÉ NEW AGREEMENT CHECKLIST

MENTOR: __________________________________

PROTÉGÉ: __________________________________________________________

MENTOR’S COGNIZANT DCMA ACO: ______________________________________

MilDep/Agency PCO/CO:________________________________________________

 _______________________________________________

MENTOR CAGE CODE: __________________________

Type of Agreement: ____Credit _____ Reimbursable 

MilDep/Agency:______________________________________

Contract Number:____________________________________

Type of Action: New Agreement ____

PACKAGE COMPLETE: YES NO

Signed Mentor-Protégé Agreement [ ] [ ]

_____________

PM Endorsement Letter (Reimbursable only) [ ] [ ] ____________

OSBP Funding Request (Reimbursable only) [ ] [ ]

_____________

Funding POC Identified (Reimbursable only) [ ] [ ]

_____________

10% incidental cost justification (if required) [ ] [ ]

_____________

Folder attached (existing agreements only) [ ] [ ]

_____________

MENTOR ELIGIBILITY: YES NO

A. NEW MENTOR – Date of Approval ____________ [ ] [ ]

_____________

B. PREVIOUSLY APPROVED MENTOR:

Semi-annual / 3-Month reports submitted? [ ] [ ] _____________

DCMA Reviews Conducted? [ ] [ ]

_____________

Past Performance Issues? [ ] [ ]

_____________

If so, please specify: 

_____________________________________________________________

PROTÉGÉ ELIGIBILITY: YES NO

SDB PRO-NET CERTIFICATION: SDB Expire Date [ ] [ ] _____________

8(a) Expire Date [ ] [ ] _____________

Minority Code [ ] [ ] _____________

WOSB [ ] [ ] _____________

VOSB [ ] [ ] _____________

Service Disabled Vet [ ] [ ] _____________
Emerging SDB [ ] [ ]

_____________

Self-Certified Organization Employing the Severely Disabled [ ] [ ] ___________

Self-Certified Woman Owned Small Business [ ] [ ]

_____________

FUNDING AVAILABILITY:

Funding Exists within Department/Agency Budget [ ] [ ]

_____________

Other: 

_______________________________________________________________________________

Department of Defense Mentor-Protégé Agreement

MENTOR-PROTÉGÉ NEW AGREEMENT CHECKLIST

AGREEMENT APPROVAL

YES NO

One Agreement for Each M/P Proposal [ ] [ ]

_____________

Firm Name/Address/Phone #/POC Mentor & Protege [ ] [ ]

_____________

Description of Developmental Assistance [ ] [ ]

_____________

Milestones for Developmental Assistance Plan [ ] [ ]

_____________

Metrics for Developmental Assistance Plan [ ] [ ]

_____________

Past and Estimated $ Subcontracts to Protégé(s) [ ] [ ]

_____________

Estimated Cost of Developmental Assistance [ ] [ ]

_____________

SIC Codes for protégé: ________________________ [ ] [ ]

_____________

NAICS Codes for protégé ________________________ [ ] [ ]

_____________

Estimate of Cost $____________________________ [ ] [ ]

_____________

Incidental Cost ($$) & (%): (not to exceed 10%)________ [ ] [ ]

_____________

Period of Performance ________________________ [ ] [ ]

_____________

Termination Procedures for Both Parties [ ] [ ]

_____________

Signed by Both Parties [ ] [ ]

_____________

[ ] [ ]

[ ] [ ]

Protégé agrees to comply with reporting/review requirements

_____________

Mentor agrees to comply with reporting/review requirements

_____________

Revised 04/25/06
Revised 04/25/06

- PREVIOUSLY PARTICIPATED AS A PROTÉGÉ:

Previous Mentor

__________________________

Term of Previous Agreement 

__________________________

Semi-annual / 3-Month Reports Received/Rebutted [ ] [ ]

_____________

DCMA Reviews Conducted [ ] [ ]

_____________

Past Performance Issues: 

______________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Approval [ ] Disapproval [ ] Initials Date