HCA OSBP Endorsement Letter Page # Contracting Officer Endorsement Letter Funding POC Identified Page # Mentor Eligibility: YES NO Previously Approved Mentor: Semi-annual reports submitted? DCMA reviews conducted: Is the Mentor currently debarred or suspended? Past performance issues? If so, please specify: Protégé Eligibility: YES NO SDB Pro-Net Certification: SDB Expriation Date 8(a) Expire Date: Employ severely disabled: WOSB: Service-Disabled Veteran-Owned: HubZone: Is the Protégé currently debarred or suspended? Agreement Approval: YES NO Description of Developmental Assistance Milestones for Developmental Assistance Plan Past and Estimated $ Subcontracts to Protégé(s) NAICS/SIC Codes for Protégé Estimate of Cost Total Incidental Cost (do not include costs for HBCU/MIs, PTACs, or SBDCs) $ & % (not to exceed 10%) Total HBCU/MI, PTAC, or SBDC Cost $ & % Period of Performance Termination Procedures for Both Parties Agreement Signed by Both Parties Protégé agrees to comply with reporting/review requirements Mentor agrees to comply with reporting/review requirements Previously Participated as a Protégé:
HCA OSBP Endorsement Letter Page # Contracting Officer Endorsement Letter Funding POC Identified Page # Mentor Eligibility: YES NO Previously Approved Mentor: Semi-annual reports submitted? DCMA reviews conducted: Is the Mentor currently debarred or suspended? Past performance issues? If so, please specify: Protégé Eligibility: YES NO SDB Pro-Net Certification: SDB Expriation Date 8(a) Expire Date: Employ severely disabled: WOSB: Service-Disabled Veteran-Owned: HubZone: Is the Protégé currently debarred or suspended? Agreement Approval: YES NO Description of Developmental Assistance Milestones for Developmental Assistance Plan Past and Estimated $ Subcontracts to Protégé(s) NAICS/SIC Codes for Protégé Estimate of Cost Total Incidental Cost (do not include costs for HBCU/MIs, PTACs, or SBDCs) $ & % (not to exceed 10%) Total HBCU/MI, PTAC, or SBDC Cost $ & % Period of Performance Termination Procedures for Both Parties Agreement Signed by Both Parties Protégé agrees to comply with reporting/review requirements Mentor agrees to comply with reporting/review requirements Previously Participated as a Protégé:
DON%20MPP%20New%20Agreement%20Checklist.docx