Report Date:

INSTRUCTIONS:

PROTÉGÉ Information:

Organization Name: Contact Name:

Address: Title:

City: Telephone:

State: FAX:

Zip: Email Address:

URL:

Industry:

Congressional District:

MENTOR Information:

Organization Name: Contact Name:

Address: Title:

City: Telephone:

State: FAX:

Zip: Email Address:

URL:

AGREEMENT Information:

Contract Number: (reimbursed agreements only):

Agreement Type:

Agency Sponsor: (if other please specify):

Period of Performance:

Start Date:

End Date:

Actual Months:

DLA Protégé Post-Agreement Report

1. Reporting requirement - reports are due for all completed, and/or terminated agreement terms, even if no activity has occurred.

2. Reporting cutoff activity captured - each year after agreement completion for 2 consecutive years

3. The report must address a complete year.

4. The first report is due 1 year & 1 month after agreement completion (e.g. agreement completion date 4/30/03, report is due 5/31/04).

 The second report is due 1 year after the first report due date (e.g. 1st report due date is 5/31/04, the 2nd report is due 5/31/05). 

5. Baseline information comes from the Mentor-Protégé Agreement.

6. Baseline revenue is the most recent full year revenue prior to the agreement completion.

7. This form has been created in MS Excel; 8 pt Arial font.

8. All dollar values are expressed in whole dollars, cents omitted.
Developmental Assistance Provided/ Milestones Achieved 2nd YEAR REPORT ONLY (DFARS I.112.2 (c)(5))

Protégé Progress Made Since exiting the MP Program (agreement completion or termination) (DFARS I.112.2 (e))

 Protégé Actual Contracts Executed (not IDIQs) from:

DoD Prime

Contract

Awards

Federal

Prime

Contract

Awards

Federal

Sub

Contract

Awards

DoD

Sub

Contract

Awards

# of DoD

Proposals

Submitted

Prev. Yr.

Baseline

(at start of agreement) $ $ $ $ $

Beginning Balance

(at end of agreement) $ $ $ $ $

End of 1st Year

Since Program Completion $ $ $ $ $

End of 2nd Year

Since Program Completion $ $ $ $ $

 Sub Total $ $ $ $ $

Ending Balance $ $ $ $ $

Total Sub

Awarded

FROM

Mentor

$

Total Sub

Awarded

FROM

Mentor

#

Mentor Sub

Awards

TO

Protégé

%

Total Sub

Awarded

TO

Mentor

$

Total Sub

Award

TO

Mentor

#

Mentor Sub

Awards

TO

Mentor

%

Baseline

(at start of agreement) $ % $ %

Beginning Balance

(at end of agreement) $ % $ %

End of 1st Year

Since Program Completion $ % $ %

End of 2nd Year

Since Program Completion $ % $ %

 Sub Total $ % $ %

Ending Balance $ % $ %

(DFARS I.112.2(c)(4))

 Actual Contracts Executed (not IDIQs) Received from Mentor:

With the signature below we certify that the representations above are true and correct to the best of our knowledge:

Send copies of this report to: DoD Office of Small Business Programs, 201 12th Street South, Ste. 406, Arlington, VA 22202 

Protégé Signature

# of

Protégé

Employees

Protégé

Annual

Gross

Revenue

Provide a brief summary of the developmental assistance plan that was provided and how this plan addressed your identified needs to 

enhance your ability to perform successfully under contracts and/or subcontracts within DoD and other federal agencies. Include 

technology transferred, enhanced capabilities(e.g. web development, and certifications obtained (e.g. ISO901:2000, MCSE). Address 

whether participation in the DoD MP Program attibuted to your success.

Provide any additional successes that your firm has achieved since the first report, that can be attributed to your participation in the DoD 

MP Program.

Date Title
Obligation Data: Invoices Submitted to DFAS:

Date Invoice # Date Amount

1 $

2

3

4

5

6

Beginning balance invoices submitted: $ 7

8

Invoices submitted this period: 9

10

Cumulative Invoices submitted: Total $0

$

$

$

Official Use Only By: OSD OSBP

 Obligation Amount

Funding Data (dollars obligated for the performance of the agreements requested by the Mentor Firm) (DFARS I.112.2 (c)(1))