FAC 97—02 OCTOBER 10, 1997

Table 15-2 FEDERAL ACQUISITION REGULATION

(2) Date of license agreement.
(3) Patent numbers.
(4) Patent application serial numbers, or other basis on which the royalty is payable.
(5) Brief description (including any part or model numbers of each contract item or component on which the royalty is payable).
(6) Percentage or dollar rate of royalty per unit.
(7) Unit price of contract item.
(8) Number of units.
(9) Total dollar amount of royalties.
(10) If specifically requested by the Contracting Officer, a copy of the current license agreement and identification of applicable
claims of specific patents (see FAR 27.204 and 31.205-37).
= Facilities Capital Cost of Money. When you elect to claim facilities capital cost of money as an allowable cost, you must submit
Form CASB-CMF and show the calculation of the proposed amount (see FAR 31.205-10).

I. Formats for Submission of Line Item Summaries

A. New Contracts (including letter contracts).

COST ELEMENTS PROPOSED CONTRACT ESTIMATE— PROPOSED CONTRACT ESTIMATE— REFERENCE
‘TOTAL COST UNIT COST
a Q) @) (4)
Column Instmuction
qa) Enter appropriate cost elements.
(2) Enter those necessary and feasonable costs that, in your judgment, will properly

be incurred in efficient coritract performance. When any of the costs in this column have
already been incurred (e.g., under a letter contract). describe them on an attached supporting
page. When preproduction or startup costs are significant, or when specifically requested to do
so by the Contracting Officer, provide a full identification and explanation of them.

(3) Optional, unless required by the Contracting Officer.
(4) Identify the attachment in which the information supporting the specific cost element may be
found.

(Attach separate pages as necessary.)
B. Change Orders, Modifications, and Claims.

(COST ELEMENTS: ESTIMATED COST OF (COST OF DELETED ‘NET COST TO BE (COST OF WORK NET COST OF ‘REFERENCE
ALL WORK DELETED ‘WORK ALREADY DELETED ‘ADDED (CHANGE
PERFORMED
0) @) 8) (3) 6) (2) 7)
Column Instmction
ql) Enter appropriate cost elements.
le Include the current estimates of what the cost would have been to complete the deleted work not
yet performed (not the original proposal estimates). and the cost of deleted work already
performed.
@) Include the incurred cost of deleted work already performed. using actuals incurred if possible,

or. if actuals are not available. estimates from your accounting records. Attach a detailed
inventory of work, materials. parts. components, and hardware already purchased.
manufactured, or performed and deleted by the change. indicating the cost and proposed
disposition of each line item. Also, if you desire to retain these items or any portion of them.
indicate the amount offered for them. .



Attachment E

Example Task 1

Individual Dose Reconstruction Review: Basic

Provide a cost estimate and workplan for completing Basic Dose Reconstruction Reviews
for 20 cases assuming 5 cases are assigned at the beginning of each quarter.

For the purposes of this proposal assume the breakdown of the cases is as follows:

1 Quarter [#of |2TM Quarter [#of [3 Quarter |#of | 4TM #of
Site cases | Site cases | Site cases | Quarter cases
Site
Hanford 2 Y-12 2 Savanah 1 Rocky 1
River Flats
INEEL 1 Metals and | 1 Combust. 1 LANL 1
Control, Eng, CT
MA
Mallinckrodt | 1 NUMEC, 1 Nevada 1 WR 1
MO PA Test Grace
Site TN
Allied 1 Linde 1 Maywood, | 1 Pantex, 1
Chemical, Ceramics NJ TX
IL NY
Harshaw 1 Lawrence | 1
Chemical, Livermore
OH CA
TOTAL 5 5 5 5

Tasks to be performed include the following:

A. Review Data Collection
1. Evaluate whether NIOSH received all requested data for the DOE or AWE site
from any relevant data source or repository
2. Evaluate whether the data used by NIOSH for the case was adequate to make a

determination with regard to probability of causation.

B. Review Interview and Documentation provided by claimant
1. Evaluate whether NIOSH appropriately addressed all of the reported work
history and events represented by the claimant including but not limited to a)
incidents or occurrences, b) actual monitoring practices, c) personal protection
practices, and d) work practices



ATTACHMENT I

We are currently responding to the Centers for Disease Control and Prevention (CDC),
Department of Health and Human Services, Request for Proposal "Insert REP Number" for the
procurement of “Insert Title of Procurement",

The CDC is placing increased emphasis on the evaluation of an offeror's past performance as a
source selection factor. The CDC is requiring clients of entities responding to their solicitation be
identified in order to verify our past performance record.

In the event you are contacted by the CDC seeking information on work that we have performed,
you are hereby authorized to respond to inquiries of the CDC.

We have identified Mr./Ms. “Insert Name of Contracting Officer, Project Officer, or Other
Individual" of your organization as the point of contact based on their knowledge concerning our
performance history.

Sincerely,


ATTACHMENT B

DHHS SMALL, DISADVANTAGED, WOMAN, HUBZone, VETERAN -OWNED
SMALL BUSINESS SUBCONTRACTING PLAN

DATE OF PLAN:
CONTRACTOR.
ADDRESS:
DUNN & BRADSTREET NUMBER:
SOLICITATION OR CONTRACT NUMBER:
ITEM/SERVICE (Description):
TOTAL CONTRACT AMOUNT: $, $
Total contract or Option #1
Base-Year, if options (if applicable)
$ $
Option #2 Option #3 Option #4
(if applicable) (if applicable) (if applicable)

TOTAL MODIFICATION AMOUNT, IF APPLICABLE $
TOTAL TASK ORDER AMOUNT, IF APPLICABLE $

PERIOD OF CONTRACT PERFORMANCE (Month, Day & Year):

The following is a suggested model for use when developing subcontracting plans as required by
P.L. 95-507 and implemented by Federal Acquisition Regulations (FAR) Subpart 19.7. While
this model plan has been designed to be consistent with statutory and regulatory requirements,
other formats of a subcontracting plan may be acceptable; however, failure to include the
essential information as exemplified in this model may be cause for either a delay in acceptance
or the rejection of a bid or offer when a subcontracting plan is required. Further, the use of this
model is not intended to waive other requirements that may be applicable under statute or
regulation. "SUBCONTRACT," as used in this clause, means any agreement (other than one
involving an employer-employee relationship) entered into by a Federal Government prime
contractor or subcontractor calling for supplies or services required for performance of the
contract or subcontract.

Subcontracting Plan
(Rev. October 2000)
1. Type of Plan (check one)


FAC 97-02 OCTOBER 10, 1997

PART 15—CONTRACTING BY NEGOTIATION Table 15-2
(4) . Enter the net cost to be deleted, which ts the estimated cost of all deleted work less the cost of
deleted work already performed. Column (2) minus Column (3) equals Column (4).
(5) Enter your esumate for cost of work added by the change. When nonrecurring costs are

significant, or when specifically requested to do so by the Contracting Officer, provide a full
identification and explanation of them. When any of the costs in this column have already
been incurred, describe them on an attached supporting schedule.

(6) Enter the net cost of change, which is the cost of work added, less the net cost to be deleted.
Column (5) minus Column (4) equals Column (6). When this result is negative, place the
amount in parentheses.

fe) Identify the attachment in which the information supporting the specific cost element may be
found.

(Attach separate pages as necessary.)

C. Price Revision/Redetermination.

CUTOFFDATE NUMBER OF UNITS NUMBER OF UNITS TO CONTRACT AMOUNT REDETERMINATION DIFFERENCE
COMPLETED BE COMPLETED PROPOSALAMOUNT
a * ) Q) ) (5) 6
(COST ELEMENTS INCURRED INCURRED OCURRED TOTALINCURRED | ESTIMATEDCOST ESTIMATED REFERENCE
cost— cost— COST—WORK IN cost TO COMPLETE TOTALCOST
PREPRODUCTION | COMPLETED PROCESS
yrs

a) (8) (9) (10) qty (2) «a3 (4)

(Use as applicable)

Column Instruction

(ld) Enter the cutoff date required by the contract, if applicable.

(2) Enter the number of units completed during the period for which experienced costs of production
are being submitted.

(3) Enter the number of units remaining to be completed under the contract.

(4) Enter the cumulative contract amount.

(5) Enter your redetermination proposal amount.

(6) Enter the difference between the contract amount and the redetermination proposal amount
When this result is negative, place the amount in parentheses. Column (4) minus Column (5)
equals Column (6).

(7) Enter appropriate cost elements. When residual inventory exists, the final costs established

under fixed-price-incentive and fixed-price-redeterminable arrangements should be net of the
fair market value of such inventory. In support of subcontract costs, submit a listing of all
subcontracts subject to repricing action. annotated as to their status.

(8) Enter all costs incurred under the contract before starting production and other nonrecurring
costs (usually referred to as startup costs) from your books and records as of the cutoff date.
These include such costs as preproduction engineering. special plant rearrangement, raining
program, and any identifiable nonrecurring costs such as initial rework, spoilage, pilot runs,
etc. In the event the amounts are not segregated in or otherwise available from your records,
enter in this column your best estimates. Explain the basis for each estimate and how the costs
are charged on your accounting records (e.g.. included in production costs as direct engineering
labor, charged to manufacturing overhead). Also show how the costs would be allocated to the
units at their various stages of contract completion.



ATTACHMENT H

This is to certify that, to the best of my knowledge and belief, the cost or pricing data {as
defined in section 15.401 of the Federal Acquisition Regulation (FAR) and required under FAR
subsection 15.403-4) submitted, either actually or by specific identification in writing, to the
Contracting Officer or to the Contracting Officer's Representative in support of

' are accurate, complete, and current as of 2. This
certification includes the cost or pricing data supporting any advance agreements and forward

pricing rate agreements between the offeror and the Government that are part of the proposal.

Firm

Signature

Name

Title

Date of execution®

' identify the proposal, request for price adjustment, or other submission involved, giving
the appropriate identifying number (e.g., RFP No.).

2 Insert the day, month, and year when price negotiations were concluded and price
agreement was reached or, if applicable, an earlier date agreed upon between the parties
that is as close as practicable to the date of agreement on price.

3 Insert the day, month, and year of signing, which should be as close as practicable to
the date when the price negotiations were concluded and the contract price was agreed
to.


ATTACHMENT G

FAC 97-22) MARCH 12, 2001

Table 15-2 FEDERALACQUISITION REGULATION

Taste 15-2—INSTRUCTIONS FOR SUBMITTING CosT/Price PROPOSALS WHEN CosT OR PRICING DATA ARE Reauirep

This document provides instructions for preparing a contract pricing proposal when cost or pricing data are required.

Note 1. There is a clear distinction between submitting cost or pricing data and merely making available books, records,
and other documents without identification. The requirement for submission of cost or pricing data is met when all accurate
cost or pricing data reasonably available to the offeror have been submitted, either actually or by specific identification, to
the Contracting Officer or an authorized representative. As later information comes into your possession, it should be
submitted promptly to the Contracting Officer in a manner that clearly shows how the information relates to the offeror’s
Price proposal. The requirement for submission of cost or pricing data continues up to the time of agreement on price, or
an earlier date agreed upon between the parties if applicable.

Note 2. By submitting your proposal, you grant the Contracting Officer or an authorized representative the nght to
examine records that formed the basis for the pricing proposal. That examination can take place at any time before award.
It may include those books, records, documents, and other types of factual information (regardless of form or whether the
information is specifically referenced or included in the proposal as the basis for pricing) that will permit an adequate
evaluation of the proposed price.

I. General Instructions

‘A. You must provide the following information on the first page of your pricing proposal:

o

(1) Solicitation, contract, and/or modification number;

(2) Name and address of offeror;

(3) Name and telephone number of point of contact:

(4) Name of contract administration office (if available);

(5) Type of contract action (that is, new contract, change order, price revision/redetermination, letter contract, unpriced order, or
other);

(6) Proposed cost; profit or fee; and total;

(7) Whether you will require the use of Government property in the performance of the contract, and, if so, what property;

(8) Whether your organization is subject to cost accounting standards; whether your organization has submitted a CASB
Disclosure Statement, and if it has been determined adequate; whether you have been notified that you are or may be in
noncompliance with your Disclosure Statement or CAS, and, if yes, an explanation; whether any aspect of this proposal is
inconsistent with your disclosed practices or applicable CAS, and, if so, an explanation; and whether the proposal is consistent
with your established estimating and accounting principles and procedures and FAR Part 31, Cost Principles, and, if not, an
explanation;

(9) The following statement:

This proposal reflects our estimates and/or actual costs as of this date and conforms with the instructions in FAR 15.403-
5(b)(1) and Table 15-2. By submitting this proposal, we grant the Contracting Officer and authorized representative(s)
the right to examine, at any time before award, those records, which include books, documents, accounting procedures
and practices, and other data, regardless of type and form or whether such supporting information is specifically
referenced or included in the proposal as the basis for pricing, that will permit an adequate evaluation of the proposed
price.

(10) Date of submission: and

(11) Name, title, and signature of authorized representative.

In submitting your proposal, you must include an index, appropriately referenced, of all the cost or pricing data and information
accompanying or identified in the proposal. In addition, you must annotate any future additions and/or revisions, up to the date
of agreement on price, or an earlier date agreed upon by the parties, on a supplemental index.

As part of the specific information required, you must submit, with your proposal, cost or pricing data (that is, data that are
Verifiable and factual and otherwise as defined at FAR 2.101). You must clearly identify on your cover sheet that cost or pricing
data are included as part of the proposal. In addition, you must submit with your proposal any information reasonably required
to explain your estimating process, including—

(a) The judgmental factors applied and the mathematical or other methods used in the estimate, including those used in projecting
from known data: and
(b) The nature and amount of any contingencies included in the proposed price.

You must show the relationship between contract line item prices and the total contract price. You must attach cost-element

breakdowns for each proposed line item, using the appropriate format prescribed in the “Formats for Submission of Line [tem


a. Submit SF-294 and attendent optional Form 312 to cognizant Contracting Officer
b. Submit SF-295 to cognizant Contracting Officer and to the:

Office of Small and Disadvantaged Business Utilization
Department of Health and Human Services

200 Independence Avenue, SW

Humphrey H. Building, Room 517-D

Washington, D.C. 20201

c, Submit "information" copy to SBA Commercial Market Representative (CMR); visit the SBA at
http://www.sba.gov/ge and click on assistance directory to locate your nearest CMR.

7. Record keeping

The following is a recitation of the types of records the contractor will maintain to demonstrate the
procedures adopted to comply with the requirements and goals in the subcontracting plan. These records
will include, but not be limited to, the following:

a. Small, disadvantaged, woman, HUBZone, veteran, and service-disabled veteran — owned small
business source lists, guides and other data identifying such vendors;

b. Organizations contacted in an attempt to locate small, disadvantaged, and woman, HUBZone, veteran,
and service-disabled veteran - owned small business sources;

c. Ona contract-by-contract basis, records on all subcontract solicitations over $100,000, which indicate

for each solicitation (1) whether small business concerns were solicited, and, if not, why not; (2)

whether HUBZone small business concerns were solicited, if not, why not; (3) whether small

disadvantage business concerns were solicited, if not, why not; (4) whether woman-owned small

business concerns were solicited, and if not, why not; (5) whether veteran or service-disabled veteran-

owned small business concerns and (6) the reason for the failure of solicited small, disadvantaged, and
woman, HUBZone, veteran, and service-disabled veteran - owned small business concerns to receive
the subcontract award;

d. Records to support other outreach efforts, e.g., contacts with minority and small business trade
associations, attendance at small and minority business procurement conferences and trade fairs;

e. Records to support internal guidance and encouragement provided to buyers through (1) workshops,
seminars, training programs, incentive awards; and (2) monitoring performance to evaluate compliance
with the program and requirements; and

f. Ona contract-by-contract basis, records to support subcontract award data including the name address,
and business type and size of each subcontractor. (This item is not required for company or
division-wide commercial products plans.)

g. Additional records:

Subcontracting Plan
(Rev. October 2000) 6


Product/Service Other |SB_ | SDB | WOSB | HUBZoneSB | Veteran

i, Provide a description of the method used to develop the subcontracting goals for small, disadvantaged,
woman, HUBZone, veteran, and service-disabled veteran - owned small business concerns. Address
efforts made to ensure that maximum practicable subcontracting opportunities have been made available
for those concerns and explain the method used to identify potential sources for solicitation purposes.
Explain the method and state the quantitative basis (in dollars) used to establish the percentage goals.
Also, explain how the areas to be subcontracted to small, disadvantaged, woman, HUBZone, veteran,
and service-disabled veteran — owned small business concerns were determined and how the capabilities
of these concerns were considered for subcontract opportunities. Identify any source lists or other
resources used in the determination process. (Attach additional sheets, if necessary.)

j. Indirect costs have have not. been included in the dollar and percentage subcontracting goals
above (check one).

k. If indirect costs have been included, explain the method used to determine the proportionate share of
such costs to be allocated as subcontracts to small, disadvantaged, woman, HUBZone, veteran, and
service-disabled veteran - owned small business concerns.

Subcontracting Plan 3
(Rev. October 2000)
3. Program Administrator:

NAME/TITLE:
ADDRESS:


Individual plan (all elements developed specifically for this contract and applicable for the full
term of this contract).

Master plan (goals developed for this contract) all other elements standardized and approved by a
lead agency Federal Official; must be renewed every three years and contractor must provide copy of lead
agency approval.

Commercial products/service plan, including goals, covers the offerer’s fiscal year and applies to
the entire production of commercial items or delivery of services sold by either the entire company or a
portion thereof (e.g., division, plant, or product line); this includes planned subcontracting for both
commercial and Government business.

2. Goals

State separate dollar and percentage goals for Small Business (SB), Small Disadvantaged Business (SDB),
Woman-owned Small Business (WOSB), Historically Underutilized Business Zone (HUBZone) Small Business,
Veteran, and “Other” than small business (OTHER) as subcontractors, for the base year and each option year, as
specified in FAR 19.704 (break out and append option year goals, if applicable) or project annual subcontracting
base and goals under commercial plans.

a. Total estimated dollar value of ALL planned subcontracting, i.e., with ALL types of concerns under this
contract is $ (b + g=100%)

b. Total estimated dollar value and percent of planned subcontracting with SMALL.
BUSINESSES (including SDB, WOB, HUBZone, Veteran, — owned ):
(%of "a") $ and % Federal Goal 23%

¢. Total estimated dollar value and percent of planned subcontracting with SMALL DISADVANTAGED
BUSINESSES: (% of "a") $ and % Federal Goal 5%

d. Total estimated dollar value and percent of planned subcontracting with WOMAN-OWNED SMALL
BUSINESSES: (% of "a") $ and % Federal Goal 5%

e. Total estimated dollar and percent of planned subcontracting with HUBZone SMALL BUSINESSES:
(% of"a") $ and % Federal Goal 2.0%

f. Total estimated dollar and percent of planned subcontracting with VETERAN SMALL BUSINESSES*
(% of "a") $ and %

g. Total estimated dollar and percent of planned subcontracting with “OTHER” THAN SMALL
BUSINESSES: (% of "a") $ and %

*Note: Service-disabled veteran goal should be included as part of veteran small business
goal.

Subcontracting Plan
(Rev. October 2000)
2

Provide a description of ALL the products and/or services, to be subcontracted under this contract, and indicate the
size and type of business supplying them (check all that apply).


FAC 97—02 OCTOBER 10, 1997

PART 1S—CONTRACTING BY NEGOTIATION Table 15-2

Summaries” section of this table. You must furnish supporting breakdowns for each cost element. consistent with your cost
accounting system.

E. When more than one contract line item is proposed, you must also provide summary total amounts covering all line items for each
element of cost.

F. Whenever you have incurred costs for work performed before submission of a proposal, you must identify those costs in your
cost/price proposal.

G. If you have reached an agreement with Government representatives on use of forward pricing rates/factors, identify the agreement,
include a copy, and describe its nature.

H. As soon as practicable after final agreement on price or an earlier date agreed to by the parties, but before the award resulting
from the proposal, you must, under the conditions stated in FAR 15.406-2, submit a Certificate of Current Cost or Pricing Data.

I. Cost Elements

Depending on your system, you must provide breakdowns for the following basic cost elements. as applicable:

A. Materials and services. Provide a consolidated priced summary of individual material quantities included in the various tasks,
orders, or contract line items being proposed and the basis for pricing (vendor quotes, invoice prices, etc.). Include raw materi-
als, parts. components. assemblies, and services to be produced or performed by others. For all items proposed, identify the item
and show the source, quantity, and price. Conduct price analyses of all subcontractor proposals. Conduct cost analyses for all
subcontracts when cost or pricing data are submitted by the subcontractor. Include these analyses as part of your own cost or pric-
ing data submissions for subcontracts expected to exceed the appropriate threshold in FAR 15.403-4. Submit the subcontractor
cost or pricing data as part of your own cost or pricing data as required in paragraph ITA(2) of this table. These requirements also
apply to all subcontractors if required to submit cost or pricing data.

(1) Adequate Price Competition. Provide data showing the degree of competition and the basis for establishing the source and
reasonableness of price for those acquisitions (such as subcontracts, purchase orders. material order, etc.) exceeding. or
expected to exceed, the appropriate threshold set forth at FAR 15.403-4 priced on the basis of adequate price competition. For
interorganizational transfers priced at other than the cost of comparable competitive commercial work of the division, sub-
sidiary, or affiliate of the contractor, explain the pricing method (see FAR 31.205-26(e)).

(2) All Other. Obtain cost or pricing data from prospective sources for those acquisitions (such as subcontracts, purchase orders,
material order, etc.) exceeding the threshold set forth in FAR 15.403-4 and not otherwise exempt, in accordance with FAR 15.403-
1(b) (ie., adequate price competition, commercial items, prices set by law or regulation or waiver). Also provide data showing
the basis for establishing source and reasonableness of price. In addition, provide a summary of your cost analysis and a copy of
cost or pricing data submitted by the prospective source in support of each subcontract, or purchase order that is the lower of either
$10,000,000 or more, or both more than the pertinent cost or pricing data threshold and more than 10 percent of the prime
contractor's proposed price. The Contracting Officer may require you to submit cost or pricing data in support of proposals in
lower amounts. Subcontractor cost or pricing data must be accurate, complete and current as of the date of final price agreement,
or an earlier date agreed upon by the parties, given on the prime contractor's Certificate of Current Cost or Pricing Data. The
prime contractor is responsible for updating a prospective subcontractor's data. For standard commercial items fabricated by the
offeror that are generally stocked in inventory, provide a separate cost breakdown. if priced based on cost. For interorganizational
transfers priced at cost, provide a separate breakdown of cost elements. Analyze the cost or pricing data and submit the results of
your analysis of the prospective source's proposal. When submission of a prospective source's cost or pricing data is required as
described in this paragraph, it must be included along with your own cost or pricing data submission, as part of your own cost or
pricing data. You must also submit any other cost or pricing data obtained from a subcontractor, either actually or by specific
identification, along with the results of any analysis performed on that data.

B. Direct Labor. Provide a time-phased (e.g., monthly, quarterly, etc.) breakdown of labor hours. rates. and cost by appropriate
category, and furnish bases for estimates.

C. Indirect Costs. indicate how you have computed and applied your indirect costs, including cost breakdowns. Show trends and’
budgetary data to provide a basis for evaluating the reasonableness of proposed rates. Indicate the rates used and provide an
appropriate explanation.

D. Other Costs. List all other costs not otherwise included in the categories described above (¢.g.. special tooling. travel, computer
and consultant services, preservation, packaging and packing. spoilage and rework. and Federal excise tax on finished articles)

E. Royalties. If royalties exceed $1,500, you must provide the following information on a separate page for each separate royalty or
license fee: .

(1) Name and address of licensor.



development organizations and local chambers of commerce; 3) attending small,
disadvantaged, woman, HUBZone, veteran, and service-disabled veteran — owned small
business procurement conferences and trade fairs; 4) requesting sources from the Small
Business Administrations (SBA) PRO-Net System and other SBA resources; and 5)
Conducting market surveys to identify new sources.

b. Internal efforts to guide and encourage purchasing personnel:

1) Conducting workshops, seminars, and training programs;

2) Establishing, maintaining, and utilizing small, disadvantaged, woman, HUBZone, veteran and
service-disabled veteran — owned small business source lists, guides, and other data for
soliciting subcontractors; and

3) Monitoring activities to evaluate compliance with the subcontracting plan.

c. Additional efforts:
5. Flow Down Clause

The contractor agrees to include the provisions under FAR 52.219-8, "Utilization of Small Business Concerns,” in
all acquisitions exceeding the simplified acquisition threshold that offers further subcontracting opportunities. All
subcontractors, except small business concerns, that receive subcontracts in excess of $500,000 ($1,000,000 for
construction) must adopt and comply with a plan similar to the plan required by FAR 52.219-9, "Small Business

Subcontracting Plan." (Flow down is not applicable for commercial items/services as described in 52.212-5(e) and
52.244-6(c).)

6. Reporting and Cooperation

The contractor gives assurance of (1) cooperation in any studies or surveys that may be required; (2) submission of
periodic reports which show compliance with the subcontracting plan; (3) submission of Standard Form (SF) 294,
"Subcontracting Report for Individual Contracts," and attendant Optional Form 312, SDB Participation Report and
SF-295, "Summary Subcontract Report,” in accordance with the instructions on the forms; and (4) ensuring that
subcontractors agree to submit Standard Forms 294 and 95.

Reporting Period Report Due Due Date
Oct 1 - Mar 31 SF-294/of 312 4/30

Apr 1 - Sept 30 SF-294/of 312 10/30
Oct 1 - Sept 30 SF-295 10/30

Special instructions for commercial products plan: SF295 Report is due on 10/30 each year for the previous fiscal
year ending 9/30.

Subcontracting Plan
(Rev. October 2000) 5


ATTACHMENT calis=

CONTRACTOR PERFORMANCE REPORT (COST TYPE CONTRACTS) (OMB No: 9000-0142)
[] Final [ ] Interim - Period Report: From. To

1. Contractor Name and Address: 2. Contract Number:.

3. Contract Value (Base Plus Option):

4. Contract Award Date:

Contract Completion Date:

5. Type of Contract: (Check all that apply) { ) CPFF - Completion [ ] CPFF - Term [{ ] CPIF [] CPAF [] CR
[] AQ [] BOA [] Requirements { ] Labor Hour [] T&M [ ] SBSA 8(a) [ ] SBIR [ ] Sealed Bid [ } Negotiated
[] Competitive { ] Non-Competitive [ JOther (Specify)__ .

6. Description of Requirement: s

7. Ratings. Summarize contractor performance and circle in the column on the right the number which corresponds to the
performance rating for each rating category. Please sec page three for explanation of rating scale.

QUALITY OF PRODUCT OR SERVICE 0
Comments:. 1
2
3
4
5

COST CONTROL 0
Comments: 1
2
3
4

s+
TIMELINESS OF PERFORMANCE 0
‘Comments:. 1
2
3
4

s+
BUSINESS RELATIONS 0
Comments: 1
2
3
4

5+

TOTAL

MEAN SCORE (Divide total rating above the number of areas rated):



ATTACHMENT C

‘SUBCONTRACTING REPORT FOR INDIVIDUAL CONTRACTS OMB No.: 9000-0006
(See instructions on reverse) Expires: 04/30/2004
Public reporting burden for this collection of information is estimated to average 9 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding ‘this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the FAR Secretariat (MVP), Acquisition Policy Division, GSA, Washington, DC
20405.

1, CORPORATION, COMPANY OR SUBDIVISION COVERED (3. DATE SUBMITTED
‘a. COMPANY NAME
b. STREET ADDRESS “4. REPORTING PERIOD FROM INCEPTION OF CONTRACT THRU:
YEAR
© CITY id. STATE Je. ZIP CODE 1 marar 1 seer so
5. TYPE OF REPORT
2. CONTRACTOR IDENTIFICATION NUMBER
oO REGULAR oO FINAL oO REVISED

6. ADMINISTERING ACTIVITY (Please check applicable box)

[army H GSA NASA
NAVY DOE OTHER FEDERAL AGENCY (Specify)
AIR FORCE (1 perense conTRACT MANAGEMENT AGENCY
7. REPORT SUBMITTED AS (Check one and provide appropriate number) 8. AGENCY OR CONTRACTOR AWARDING CONTRACT
PRIME CONTRACT NUMBER fa. AGENCY'S OR CONTRACTOR'S NAME
C1 prime contractor
[SUBCONTRACT NUMBER Ib. STREET ADDRESS
CA suscontractor
9, DOLLARS AND PERCENTAGES IN THE FOLLOWING BLOCKS: ic. CITY id. STATE |e. ZIP CODE
[21 10 netupe inpiRecT costs [bo nor inctupe inpiRect costs
SUBCONTRACT AWARDS
TYPE CURRENT GOAL ACTUAL CUMULATIVE
‘WHOLE DOLLARS. PERCENT WHOLE DOLLARS | PERCENT

TOa. SMALL BUSINESS CONCERNS (Include SDB, WOSB,

HBCU/MI, HUBZone SB, and VOSB (Including

Service Disabled VOSB)) (Dollar Amount and Percent

of.
10b. LARGE BUSINESS CONCERNS (Dollar Amount and

Percent of 10c.)
10c. TOTAL (Sum of 10a and 10b.) 100.0% 100.0%
11. SMALL DISADVANTAGED BUSINESS (SDB) CONCERNS

(include HBCU/MI) (Dollar Amount and Percent of 10c.)
12. WOMEN-OWNED SMALL BUSINESS (WOSB) CONCERNS

(Dollar Amount and Percent of 10c.)
13. HISTORICALLY BLACK COLLEGES AND UNIVERSITIES

(HBCU) AND MINORITY INSTITUTIONS (Ml) (/f applicable)

(Dollar Amount and Percent of 10c.)
14, HUBZone SMALL BUSINESS (HUBZone SB) CONCERNS

(Dollar Amount and Percent of 10c.)
15. VETERAN-OWNED SMALL BUSINESS CONCERNS

Grcluding Service-Disabled Veteran-Owned SB Concerns)

(Dollar Amount and Percent of 10c.)
16. SERVICE-DISABLED VETERAN-OWNED SMALL

BUSINESS CONCERNS (Dollar Amount and Percent

of10c.)
17. REMARKS:
Téa, NAME OF INDIVIDUAL ADMINISTERING SUBCONTRACTING PLAN Tob. TELEPHONE NUMBER

[AREA CODE [NUMBER

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 294 (REV. 9/2001)

Previous edition is not usable Prescribed by GSA-FAR (48 CFR) 53.219(a)


SIGNATURE PAGE

(applies to Master or Commercial type plans)
This master or commercial type subcontracting plan is submitted by:

Contractor:

Contractor Signature:

Typed Name:

Title:

Date Prepared:

And Is Accepted By:

Agency:

Contracting Officer Signature:

Typed Name:

Date:

Subcontracting Plan
(Rev. October 2000) 7


TELEPHONE/E-MAIL:

Duties: Has general overall responsibility for the company's subcontracting program, i.e., developing, preparing,
and executing subcontracting plans and monitoring performance relative to the requirements of those subcontracting
plans. Other duties include, but are not limited to, the following activities:

a.

Developing and promoting company-wide policy initiatives that demonstrate the company's support for
awarding contracts and subcontracts to small, disadvantaged, woman, HUBZone, veteran, and service-
disabled veteran - owned small business concerns; and for assuring that these concerns are included on
the source lists for solicitations for products and services they are capable of providing.

Developing and maintaining bidder source lists of small, disadvantaged, woman, HUBZone, veteran,
and service-disabled veteran — owned small business concerns from all possible sources;

Ensuring periodic rotation of potential subcontractors on bidder's lists;

Ensuring that requests for contracts (RFC) are designed to permit the maximum practicable
participation of small, disadvantaged, woman, HUBZone, veteran, and service-disabled veteran —
owned small businesses;

Accessing various sources for the identification of small, small disadvantaged, woman-owned and
HUBZone, veteran, and service-disabled veteran — owned small business concems to include the SBA's
PRO-Net System, the Federal Acquisition Computer Network (FACNET) Contractor Registration
Database, the National Minority Purchasing Council Vendor Information Service, the Office of
Minority Business Data Center in the Department of Commerce, local small business and minority
associations, contact with local chambers of commerce and Federal agencies' Small Business Offices;

Establishing and maintaining contract and subcontract award records;

Participating in Business Opportunity Workshops, Minority Business Enterprise Seminars, Trade Fairs,
Procurement Conferences, etc;

Ensuring that small, disadvantaged, woman, HUBZone, veteran, and service-disabled veteran - owned
small business concerns are made aware of subcontracting opportunities and assisting concerns in
preparing responsive bids to the company;

Conducting or arranging for the conduct of training for purchasing personnel regarding the intent and
impact of Public Law 95-507 on purchasing;

Monitoring the company's subcontracting program performance and making any adjustments necessary
to achieve the subcontract plan goals;

Preparing, and submitting timely, required subcontract reports;

Coordinating the company's activities during the conduct of compliance reviews by Federal agencies;
and

Other duties:

Subcontracting Plan 4
(Rev. October 2000)
4. Equitable Opportunity

Describe efforts the offeror will make to ensure that small, disadvantaged, woman, HUBZone, veteran, and service-
disabled veteran - owned small business concerns will have an equitable opportunity to compete for subcontracts.
These efforts include, but are not limited to, the following activities:

a. Outreach efforts to obtain sources:


15.501

FAC 97-21 JANUARY 19, 2001

FEDERALACQUISITION REGULATION

(9)

(10)

qu)
(2)

(13)
(4)

Enter in Column (9) the production costs from your books and records (exclusive of
preproduction costs reported in Column (8)) of the units completed as of the cutoff date.
Enter in Column (10) the casts of work in process as determined from your records or inventones
at the cutoff date. When the amounts for work in process are not available in your records but
reliable estimates for them can be made, enter the estimated amounts in Column (10) and enter
in Colurnn (9) the differences between the total incurred costs (exclusive of preproduction
costs) as of the cutoff date and these estimates. Explain the basis for the estimates, including
identification of any provision for experienced or anticipated allowances, such as shrinkage,
rework, design changes, etc. Furnish experienced unit or lot costs (or labor hours) from
inception of contract to the cutoff date, improvement curves, and any other available
production cost history pertaining to the item(s) to which your proposal relates.
Enter total incurred costs (Total of Columns (8), (9), and (10)).
Enter those necessary and reasonable costs that in your judgment will properly be incurred in
completing the remaining work to be performed under the contract with respect to the item(s)
to which your proposal relates.
Enter total estimated cost (Total of Columns (11) and (12)).
Identify the attachment in which the information supporting the specific cost element may be
found.

Attach separate pages as necessary.)



Block |:

Block 2:

Block 3:

Block 4:

Block 5:

Block 6:

Block 7:

Block 8:

Block 9:

Block 10:

Blocks 11-12:

Block 13:

Block 14:

Block 15:

CONTRACTOR PERFORMANCE REPORT INSTRUCTIONS

Contractor Name and Address. Identify the specific division being evaluated if there is more than
one.

Contract number of contract being evaluated.

Contract value shall include base plus options. If funding was increased or decreased during the
instant evaluation period, the value in this block should reflect the change.

Contract award date and anticipated or anticipated contract completion date.
Type of contract: Check all that apply.

Provide a brief description of the work being done under the contract and identify the key
performance indicators. This description will allow agencies calling for reference checks to compare
statements of work.

Circle rating in far right column and provide brief narrative for each of the categories rated. Indicate
the contract requirements thst were exceeded or were not met by the contractor and by how much.
Also calculate the mean score of the ratings.

List the names and employment dates of the contractor's key personnel. This will provide a record of -
how long these managers worked on the contract. If there were many changes in these managers &
second page may be necessary. On the comment/rating line briefly describe the managers
performance.

If given a choice, please explain why you would or why you would not select the contractor for this
contract again.

The program office person most familiar with the contractor’s performance should sign this block.
The rating is a combined program office, contracting officer decision. The contracting officers
signature in block 15 signifies concurrence with this rating and the final rating, if a revised rating is
necessary.

The contractor may provide comments but must sign block 12 to indicate review of the rating.

If the contractor and contracting officer are unable to agree on a final rating, an agency review at @
level above the contracting officer is required.

Adjust the ratings assigned in block 7, if appropriate, based on any comments, rebuttals, or additional
information provided by the contractor and, if necessary, by the agency review. Calculate a mean
score of the contractor's performance.

The contracting officer's signature certifies concurrence with the initial and final ratings.


Cc.

2. Assure that interview information is consistent with data used for dose
estimate, and if not, there is reasonable justification.

Review Internal and External Dose Estimates

1. Evaluate whether all assumptions used in the dose determination are
appropriate for a remedial compensation program and whether the benefit of the
doubt was resolved in favor of the claimant

2. Verify dose calculations are appropriate for purposes of determination of POC
3. Evaluate whether the data were consistent with site radiological monitoring
protocols of the time period.

4. Evaluate the treatment of ‘missed dose’ and/or ‘unmonitored dose’ if relevant
to the case.

5. The review of each dose reconstruction shall include an evaluation of all
relevant portions of the methods and/or procedures used by NIOSH. This
includes, but is not limited to:

a. Review the internal and external radiation dose reconstruction
technical basis documents,

b. Review of methods for estimating ‘missed dose’ and ‘un-monitored
dose’ (for cases related to monitoring technology and for cases where
monitoring was not performed, monitoring data is not available or
incomplete or otherwise inadequate),

c. Review of the statistical approaches developed for multiple dose
reconstructions,

d. Review procedures used for determining whether data is sufficient to
make a reasonable dose estimate,

e. Review methods or procedures used for substituting exposure
information for unavailable or incomplete information,

f. Review methods for estimating uncertainty in dose and uncertainty
distributions surrounding internal and external dose reconstructions on
a facility and time specific basis and evaluate whether the benefit of
the doubt was resolved in favor of the claimant where there were
uncertainties,

g. Review procedures and questionnaire used for work history phone
interview.

h. Review the NIOSH methods, procedures and performance in
evaluating, analyzing and validating all contractor work products.


GAO, DNFSB, Congressional Hearing Records, other research programs,
research publications, publications regarding the history of the DOE complex,
or administrative/court records) were identified, evaluated and where
appropriate, included within the Site Profile database and where appropriate
were used in the assessment of the individual dose reconstruction case.

B. Review Work History Interview and Documentation provided by claimant

1. Evaluate the effectiveness of the phone interview in ascertaining
relevant work history information.

2. Evaluate whether, for the cases involving survivors, there has been an
adequate effort to research co-located workers and other historical
records to characterize the individual’s work history.

C. Review Internal and External Dose Estimates

1. Evaluate whether the dose estimate is consistent with relevant radiological
information within the NIOSH site profile (e.g. air monitoring, wipe data
are consistent with bioassay results)

2. Compare case information and assumptions with relevant co-worker case
information and assumptions for consistency


RATING GUIDELINES

Summarizs contractor performance in each of the rating areas. Assign each area a rating of © (Unsatisfactory), 1 (Poor), 2 Fair), 3
(Good), 4 Excellent), or +Plus). Use the following instructions as guidance in making these evaluations.

Business
Quality of Product/Service ‘Cost Control Timeliness Relations
-Compliance with contract -Within budget (overAunder -Net interim milestones _-Efffective Management
requirements targeted costs) -Reliable -Businesslike correspon-
-Accuracy of reports ~Current, accurate, and “Responsive to technical dence
Appropriateness of personnel complete billings Responsive to contract
Technical excellence -Relationship of negotiated Conplaed on time, requirements
costs to actuals including wrap-up and -Prompt notification of
Cost efficiencies contract administration problems
-Change orders -No liquidated damages _-Reasonable/cooperative
assessed -Flexible
. -Pro-active
-Effective contractor
recommended solutions
-Effective small/small
disadvantaged business
subcontracting program
0. Unsatisfactory Nonconformances are Cost issues are Delays are Response to inquiries
compromising compromising compromising the technical/service
achievement of contract performance of contract achievement of contract administrative issues is
requirements despite requirements requirements, despite not effective and
use of Agency us of Agency resources _ responsive
resources
1. Poor Nonconformances Cost issues require Delays require major Response to inquiries
require major Agency major Agency Agency resources to technical/service
resources to ensure resources to ensure ensure achievement of administrative issues is
achievement of contract achievement of contract contract requirements marginally effective and
requirements requirements responsive
2. Fair Nonconformances Cost issues require Delays do not Response to inquiries
require minor Agency minor Agency significantly impact technical/service
Tesources to ensure resources to ensure achievement of contract sdministrative issues is
achievement of contract achievement of contract requirements usually effective and
requirements requirements responsive
3. Good Nonconformances do Cost issues do not Delays do not impact Response to inquiries
not impact achievement impact achievement of achievement of contract technical/service
of contract contract requirements requirements administrative issues is
requirements usually effective and
responsive
4. Excellent There are no quality ‘There are no cost issues There are no delays Response to inquiries
problems technical/service
administrative issues is
effective and
responsive

5. PLUS

The contractor has demonstrated an exceptional performance level in any of the above four categories
that justifies adding a point to the score. It is expected that this rating will be used in those rare
circumstances when contractor performance clearly exceeds the performance levels described as

"Excellent."


8. KEY PERSONNEL
Project Manager: Name:. . Employment Dates,
Comments/Rating:
Name: Employment Dates,
‘Comments/Rating:
Name: Employment Dates.
‘Comments/Rating:
N
Name: Employment Dates.
CommentsRating:
9. Would you select this firm again? Please explain.
10. Project Officer Name: Signature:
Date:

11, CONTRACTORS REVIEW: Were comments, rebuttals, or additional information provided? ( ] No[] Yes. Please
attach comments.

12. Contractor Name: Signature:
Phone:
Fax: . Date:
Internet address:

13. AGENCY REVIEW: Were contractor comments reviewed at a level above the contracting officer? [ ] No [} Yes.
Comments attached.

14. FINAL RATINGS: Re-assess the Block 7 ratings based on contractor comments and agency review. Validate or
revise as appropriate.

Quality___ Cost Control Timeliness, Business Relations.
Mean Score (Add the ratings above and divide by number of areas rated):
15. Contracting Officer’s Name:. Signature:
Phone:. Date:
FAX#:.
Internet Address:.



ATTACHMENT D

SUMMARY SUBCON T RAC T REPOR T OMB No.: 9000-0007
(See instructions on reverse) Expires: 09/30/2003

Public reporting burden for this collection of information is estimated to average 15.9 hours per response, including the time for reviewing instructions,
searching existing data sources. gathering and maintaining the data needed, and completing and reviewing the collection of information. Send

‘comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the
FAR t (MVP), Acquisition Policy Division, GSA, Washington, DC 20405.
1. CORPORATION, COMPANY OR SUBDIVISION COVERED [3. DATE SUBMITTED

‘a. COMPANY NAME

b. STREET ADDRESS “4. REPORTING PERIOD:
YEAR
©. CITY id. STATE |e. ZIP CODE O re o Raa
5. TYPE OF REPORT
@. CONTRACTOR IDENTIFICATION NUMBER
1 recuar (1) rina () reviseo
6. ADMINISTERING ACTIVITY (Please check applicable box)
ARMY DEFENSE CONTRACT MANAGEMENT AGENCY DOE
NAVY NASA OTHER FEDERAL AGENCY (Specify)
‘AIR FORCE GSA
7. REPORT SUBMITTED AS (Check one ) 8. TYPE OF PLAN
PRIME CONTRACTOR INDIVIDUAL {F PLAN IS A COMMERCIAL PLAN, SPECIFY THE Y
SUBCONTRACTOR PERCENTAGE OF THE DOLLARS ON THIS REPORT
BOTH COMMERCIAL PRODUCTS _| ATTRIBUTABLE TO THIS AGENCY.
‘9, CONTRACTOR'S MAJOR PRODUCTS OR SERVICE LINES
a b

CUMULATIVE FISCAL YEAR SUBCONTRACT AWARDS
(Report cumulative figures for reporting period in Block 4)

PERCE
TYPE WHOLE DOLLARS — (To nearest tenth
a

10a. SMALL BUSINESS CONCERNS (Include SDB, WOSB, HBCU/MI, HUBZone SB, and VOSB
(including Service-Disabled VOSB)) (Dollar Amount and Percent of 10c.)

10b. LARGE BUSINESS CONCERNS (Dollar Amount and Percent of 10c.)

10c. TOTAL (Sum of 10a and 10b.) “100.0%

11. SMALL DISADVANTAGED BUSINESS (SDB) CONCERNS (Include HBCU/MI)
(Dollar Amount and Percent of 10c.)

12. WOMEN-OWNED SMALL BUSINESS (WOSB) CONCERNS
(Dollar Amount and Percent of 10c.)

13. HISTORICALLY BLACK COLLEGES AND UNIVERSITIES (HBCU) AND MINORITY
INSTITUTIONS (MI) (if applicable) (Dollar Amount and Percent of 10c.)

14. HUBZONE SMALL BUSINESS (HUBZone SB) CONCERNS
(Dollar Amount and Percent of 10c.)

15. | VETERAN-OWNED SMALL BUSINESS (VOSB) CONCERNS (Including Service-Disabled
VOSB Concerns) (Dollar Amount and Percent of 10c.)

16. SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS CONCERNS
(Dollar Amount and Percent of 10c.)

17, REMARKS:

18. CONTRACTOR'S OFFICIAL WHO ADMINISTERS SUBCONTRACTING PROGRAM

‘a. NAME [b. TITLE c. TELEPHONE NUMBER
. [AREA CODE [NUMBER

19. CHIEF EXECUTIVE OFFICER

a. NAME ic. SIGNATURE
b. TITLE }d. DATE
AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 295 (Rev. 9-2001)

Previous edition is not usable Prescribed by GSA - FAR (48 CFR) 53.219(b)


Attachment F

Example Task 2

Individual Dose Reconstruction Review: Advanced

Provide a cost estimate and workplan for completing Advanced Dose Reconstruction
Reviews for 20 cases assuming 5 cases are assigned at the beginning of each quarter.

For the purposes of this proposal assume the breakdown of the cases is as follows:

1* Quarter #of |2TM Quarter |#of [3 Quarter [#of | 4" #of
Site cases | Site cases | Site cases | Quarter cases
Site
Hanford 2 Y-12 2 Savanah 1 Rocky 1
River Flats
INEEL 1 Metals and | 1 Combust. 1 LANL 1
Control, Eng, CT
MA
Mallinckrodt | 1 NUMEC, 1 Nevada 1 WR 1
MO PA Test Grace
Site TTMN
Allied 1 Linde 1 Maywood, | 1 Pantex, 1
Chemical, Ceramics NJ TX
IL NY
Harshaw 1 Lawrence | 1
Chemical, Livermore
OH CA
TOTAL 5 5 5 5

Tasks to be performed include the tasks required for the Basic Review (see Attachment
D, example 1) along with the following additional tasks:

A. Review of Data Gathering

1. Review the entire administrative record to evaluate if relevant information
exists which was not considered by NIOSH
2. Review the relevant aspects of the Site Profile as they apply to the individual

case and evaluate the adequacy and completeness of the site profile and

evaluate whether the information from the site profile is consistent with the

information used for the individual dose estimate.

3. Evaluate whether, to the extent practicable, all relevant sources of data (e.g.,
DOE, AWE, CDC, EML, NRC, EPA, External Health and Safety Regulators,