SMALL BUSINESS COORDINATION RECORD - Agil3 Tech

1 SMALL BUSINESS COORDINATION RECORD (See DFARS PGI for form completion instructions.)1. CONTROL NO. (Optional)6a. CONTRACTING OFFICER NAME (Last, First, Middle Initial)d. EMAIL ADDRESSe. TELEPHONE NUMBER (Include Area Code)4a. PIID c. OFFICE SYMBOLb. DODAAC 5. SUPPLEMENTARY PIID b. PIID 2 (If applicable)3. TOTAL ESTIMATED VALUE (With options)2. PURCHASE REQUEST/ REQUISITION ITEM AND/OR SERVICE DESCRIPTION8. PERIOD OF PERFORMANCE/DELIVERY DATES (Including options)10. RECOMMENDATION (X all that apply)11a. MARKET RESEARCH/ACQUISITION PLAN12. CONSOLIDATED OR BUNDLED (X as applicable)13. SUBCONTRACTING PLAN REQUIRED (X one)9.

2 PURPOSE OF COORDINATION (X one)b. PRODUCT OR SERVICE CODEd. SIZE STANDARDc. NAICS CODEI nitial CoordinationWithdrawalChange100%PartialC ompetitiveSole SourceCompetitiveCompetitiveSole SourceSole Source%b. SECTION 8(a) (X one)c. HISTORICALLY UNDERUTILIZED BUSINESS ZONE (HUBZone) SMALL BUSINESS (X one)d. SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB) (X one)e. ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS (EDWOSB) SET-ASIDEf. WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER WOSB PROGRAM SET-ASIDEh. OTHER THAN FULL AND OPEN COMPETITION NOT PREVIOUSLY ADDRESSEDc. SMALL BUSINESS PROGRESS PAYMENTS (X one)i.

3 FULL AND OPEN COMPETITION (Complete block 13)HUBZONE PRICE EVALUATION PREFERENCE (Ref. FAR )j. MULTIPLE AWARD: ContractReserves (FAR ) (List type(s) of SMALL BUSINESS , , WOSB, SDVOSB)Delivery/Task Orderg. OTHER SET-ASIDE (Cite authority, , FAR or ; or DFARS )a. SMALL BUSINESS SET-ASIDE (X one)b. SYNOPSIS REQUIRED (X one) a. CONSOLIDATED REQUIREMENT (Attach required documentation per DFARS ) b. BUNDLED REQUIREMENT (Attach required documentation per FAR including benefit analysis.)Yes(NOTE: Synopsis not required if <$25,000; see FAR (a)(1).)No (Provide FAR exception)YesYesYesYesNoNoNoNoDD FORM 2579, AUG 2015 Adobe Designer EDITION IS ACQUISITION HISTORY a.

4 IS THIS A NEW REQUIREMENT? (X one) b. PREVIOUSLY CONSOLIDATED OR BUNDLED? (X one) c. DETAILS OF PREVIOUS AWARD(S) (List details requested in instructions. Attach additional page(s) if necessary.)Yes (Proceed to Block 15)No (Continue to Blocks a(1) through (10), marking all that apply for the immediately preceding acquisition.)100%PartialCompetitiveSole Source%(2) SECTION 8(a) (X one)(1) SMALL BUSINESS SET-ASIDE (X one)Sole SourceCompetitiveCompetitiveSole Source(3) HISTORICALLY UNDERUTILIZED BUSINESS ZONE (HUBZone) SMALL BUSINESS (X one)(4) SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB) (X one)(5) ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS (EDWOSB) SET-ASIDE(6) WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER WOSB PROGRAM SET-ASIDE(8) OTHER THAN FULL AND OPEN COMPETITION NOT PREVIOUSLY ADDRESSED(9) FULL AND OPEN COMPETITION (Complete block 13)HUBZONE PRICE EVALUATION PREFERENCE (Ref.)

5 FAR )(10) MULTIPLE AWARD: ContractReserves (FAR ) (List type(s) of SMALL BUSINESS , , WOSB, SDVOSB)Delivery/Task Order(7) OTHER SET-ASIDE (Cite authority, , FAR or ; or DFARS )NoYes(2) BUNDLED NoYes(1) CONSOLIDATED15. CONTRACTING OFFICER a. NAME (Last, First, Middle Initial) c. SIGNATURE f. SMALL BUSINESS PROFESSIONAL/ SMALL BUSINESS DIRECTOR REMARKSb. EMAIL ADDRESSd. DATE SIGNED (YYYYMMDD) c. SIGNATURE d. DATE SIGNED (YYYYMMDD)16. SMALL BUSINESS PROFESSIONAL/ SMALL BUSINESS DIRECTOR REVIEWa. NAME (Last, First, Middle Initial) c. SIGNATURE b. DATE SIGNED (YYYYMMDD)a. SIGNATURE b. EMAIL ADDRESSd. DATE SIGNED (YYYYMMDD)e. DATE ACQUISITION PACKAGE PROVIDED TO SBA (FAR (e)) (YYYYMMDD) e.

6 SBA PROCUREMENT CENTER REPRESENTATIVE REMARKS c. CONTRACTING OFFICER REMARKSC oncurNon-concur17. SBA PROCUREMENT CENTER REPRESENTATIVE REVIEW18. CONTRACTING OFFICER REVIEWa. NAME (Last, First, Middle Initial)b. EMAIL ADDRESSC oncurNon-concurConcur with PCR recommendationReject PCR recommendationDD FORM 2579 (BACK), AUG 2015