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(1) Page 9 of Standard Form 251.

20. EXHIBITS

OF COMPLETED

WORK

Inless specifically requested, submission of photographs is optional. lihere submitted, furnish one exterior and one interior photogruph of five examples of
completed architecturul uork that are listed in items 18 und 19. (l'hotographs ul models, renderings, sketches, etc., are 107 desired.) Size of photographs
not to exceed 8'" x 11". On the back of each photograph give the following information: !) name of your firmi (2) Aame and address of client; 13) Type of
structure; (4) Location of structure; (5) Costo specific structure Photographs of electrical or mechanical facilities und uther components of a decided
engineering character are not necessary.
A. C'RRENT STATUS (Check one

D, CLEARED BY

L, MAY PRINCIPALS BEEN CLEARED

6. DEGREE OF CLEARANCE

C. DATE OF CLEARANCE

21.

SECURITY CLEARANCE (See Note d)

ACTIVE

INACTIVE

NONE

YES

NO

22. IN THE EVENT SPACES PROVIDED ON THE FORM ARE NOT SUFFICIENT FOR ENTRIES, OR IF YOU WISH TO FURNISH ADDITIONAL INFORMATION, 11 MAY HE JNSERTED HERE, ON THE REVERSE

OF THIS PAGE, OR ON SEPARATE SHEETS, WITH APPROPRIATE REFERENCES.

SPECIMEN

23.

PURPOSE OF SUBMITTING THIS QUESTIONNAIRE

(Check A or B, not both)

A. I/We wish to be considered for architectural or engineering services in connection with the design, inspection, supervision (check applicable box

,

or boxes) of construction projects for Federal Agencies.

NAME OF FIRM ASSOCIATED WITH

B. This completed questionnaire is submitted as evidence of employment os outside associate or consultant.

(See item 12.)

As of this date:

the foregoing is a true statement of facts.

NAME OF FIRM OR INDIVIDUAL SUBMITTING QUESTIONNAIRE

TYPE NAME AND TITLE OF PERSON SIGNING

SIGNATURE

(a)

be completed by typewriter. Completed loms may be reproduced In any quantity decmed necessary to meet distribution requirements. NOTES: (b) It will be to a firm's advantage to maintain its experience record on a current

basis. This may be accomplished by periodically forwarding curent date.

(c) It is NOT necessary for individuals or firms who check Item 23B to fur

nish separate questionnaires for their cutside associates and consul

tants.
(d) Item 21 is to consideration only with respect to classified projects.

STANDARD FORM 251
JUAC 1001

§ 1-16.902 Optional forms.

Optional forms are illustrated in this section in the same manner and for the same purpose as is stated in § 1-16.901 for standard forms. [30 F.R. 9593, July 31, 1965] § 1-16.902-OF-17 Optional Form 17, Sealed Bid Label.

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§ 1–16.902-OF-61 Optional Form 61: Small Business Subcontracting Program

Quarterly Report of Participating Large Company on Subcontract Commitments

to Small Business Concerns. (a) Page 1 of Optional Form 61.

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GENERAL INSTRUCTIONS 1. This report is to be submitted for each calendar quarter by all contractors maintaining SMALL BUSINESS SUBCONTRACTING PROGRAMS, and required to report. The original and

Mis of each report shall be submitted to:

SPECIMEN

Reports shall be submitted on the erdhi

after the close of the quarter being reported. Data pertaining to individual companies will be 2. Each reporting company, dtmisi. Ar pher shall report the required information for the reporting unit as a whole on the basis of the total "mix” of contratenbagency business (e.g., commitments for subcontracting work shall not be segregated as between subcontracts under prime or under subcontracts).

SPECIFIC INSTRUCTIONS ITEM 1. Specify the agency and its representative who established reporting arrangements under the Subcontracting Small Business Program. ITEM 2. Enter the day, month and year of the first and last days of the period covered by this report. ITEM 3. Enter the name of the reporting company or subdivision thereof (e.g., division or plant) which is covered by the data submitted. A company m.y elect to report on a corporate, division or plant basis. ITEM 4. If the report is for a division, plant or other subdivision of a company, enter the name of the company of which the reporting subdivision is a part. ITEM 5a. Enter the net dollar amount of the commitments made by the reporting organization during the quarter to small business concerns for agency (see Item 1) subcontracts and purchases. The repor ng company may accept the representation of a supplier that it is a small business concern under Delinition No. 1.

b. Enter the ner dollar amounts of commitments made by the reporting organization during the quarter to large business concerns for agency (see Item 1) subcontracts and purchases.

c. Énter the total ner dollar amount of commitments made by the reporting organization during the quarter to all business concerns for agency (see Item 1) subcontracts and purchases. ITEM 6. Self explanatory. ITEM 7. Enter the date (day, month, year) this report is submitted.

DEFINITIONS 1. SMALL BUSINESS CONCER.V. A small business concern is a concern that meets the pertinent criteria established by the Small Business Administration and set forth in Title 13, Chapter 1, Part 121 of the Code of Federal Regulations. 2. SUBCONTRACTS AND PURCHASES. Subcontracts and purchases as used herein means procurement by a business concern of any article, material or service, including agency (see Item 1) portion of 'stock inventory and, where reasonably determined to be attributable to such agency contracting, purchases of plant maintenance, repair, operation, and capital equipment, entering into the performance of such agency supply, service or facility contract received by that business concern from (i) 'the

(INSTRUCTIONS CONTINUED ON REVERSE)

5061-101

OPTIONAL FORM NO. 61
June 1968
FPR (41 CFR) 1-16.804

(b) Page 2 of Optional Form 61.

agency (see Item 1), or (ii) another business concern. Procurement of Experimental, Development and Research work is to be included. 3. COMMITMENTS. Commitments as used herein means contracts, purchase orders or other legal obligations executed by the reporting Company for goods and services to be received by the reporting Company. Commitments shall include increases to purchase orders and contracts less downward adjustments to purchase orders and contracts as a result of contract changes, cut-backs, or terminations. 4. SUBCONTRACT AND PURCHASE COMMITMENTS. Subcontract and purchase commitments will include all commitments (net, after adjustments) to a supplier of subcontracted or purchased articles, materials or services, as defined in 2 above, except purchases from a company, division, or plant which is an affiliate of the reporting company.

SPECIMEN

PAGE 2

U.S. GOVERNMENT PRINTING OFFICE: 1964 OF-340-453 (2-))

OPTIONAL FORM NO. 61
June 1968
FPR (41 CFR) 1-16.804

[33 F.R. 17295, Nov. 22, 1968)

NOTE: Agencies may enter the letters N.A. (meaning not available) in each block where data is called for by the forms and the data is not available by the close of the first reporting period (1.e., June 30, 1969) because of necessary changes in systems employed to collect the data.

8 1-16.903 Department of Justice lustrated in this section in the same forms.

manner and for the same purpose as is Department of Justice forms are 1l- stated in § 1-16.901 for standard forms. § 1-16.903–DJ-1500 Form DJ-1500: Identical Bid Report for Procurement.

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PART 1-17-EXTRAORDINARY CON

TRACTUAL ACTIONS TO FACILI

TATE THE NATIONAL DEFENSE Sec. 1-17.000 Scope of part.

Subpart 1-17.1-General 1-17.101 Authority. 1-17.102 General policy. 1-17.103 Types of actions. 1-17.104 Definitions. 1-17.105 Reports. Subpart 1-17.2—Requests for Contractual

Adjustment 1--17.200 Scope of subpart. 1--17.201 [Reserved] 1-17.202 (Reserved] 1-17.203 (Reserved] 1-17.204 Standards for deciding cases. 1-17.204-1 General. 1-17.204-2 Amendments without considera

tion. 1-17.204-3 Mistakes. 1-17.2044 Informal commitments. 1-17.205 Limitations upon exercise of

authority.

Sec. 1-17.205–1 General limitations. 1-17.205–2 Additional limitations below sec

retarial level. 1-17.206 Contractual requirements. 1-17.207 Requests by contractors. 1-17.207–1 Filing requests. 1-17.207–2 Form of requests. 1-17.207-3 Preliminary record of requests. 1-17.207-4 Facts and evidence. 1-17.208 Processing cases. 1-17.208–1 Investigation. 1–17.208–2 Interagency coordination. 1–17.208–3 Disposition. 1-17.208-4 Records.

Subpart 1-17.3—Residual Powers 1-17.300 Scope of subpart. 1-17.301 Statutory limitation on delega

tion of authority. 1-17.302 Standards for using residual

powers. 1-17.303 Procedures. 1-17.304 Records. Subpart 1-17.4—Records of Requests and

Dispositions 1-17.400 Scope of subpart. 1-17.401 Preliminary records.

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