Form SBA Form 1531 SBA Form 1531 Certificate of Competency Application

Control No. 3245-0225
Exp. Date: XXXXX

SMALL BUSINESS ADMINISTRATION

APPLICATION FOR CERTIFICATE OF COMPETENCY

COC Case Number:

Instructions: The Certificate of Competency (COC) program allows a small business to appeal a contracting officer's determination that it lacks the responsibility
necessary to perform a specific government procurement on which it is an apparent successful offeror. This form (SBA Form 1531) should be completed by a small
business concern seeking a COC determination from SBA affirming that it is responsible to perform the specific procurement. The small business must complete
questions 10-18 in Part I. (SBA will complete questions 1-9 and 19), all questions in Parts II and III, and the certification in Part IV. The completed form must be submitted
to an SBA Area Director serving your geographic area. For more information visit, http://www.sba.gov/content/certificate-competency-program
Basis of Referral:
Capacity

PART I

Credit

Capability

Other

1. U.S. Small Business Administration (Office)

Explain
Procurement Designation (Solicitation Number)
Set-Aside

Unrestricted

2. Next Apparent Successful Offeror-- Whether large or small business,
price difference.
3. Name and Address of Contracting Agency

Buyer
Phone
C/0
Phone

a.
----------------------------_
-----------------------------

Email
Fax
4. Name of Company, Address (Street, City State, ZIP Code)

County:

Email Address:

County:

Contact Name:

9. What are contract delivery and special provision requirements of contract?

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Total Offered Price
Progress Payments
Available?

Functions at Location

Email:

Yes

d.
e.

Website:

8. Brief Description of Solicited Items or Services

9a. Was Pre-award Survey Conducted?

Unit Price, if applicable

Title

6. Work Performance Location , if different from the above address
(street, City, State, ZIP Code)

7. Telephone No. (Include Area Code)

Increase Option

C.

Principal Company Officials (Attach Resumes)
Name

5. Telephone No. (Include Area Code)

Quantity

b.

No If so, date of Pre-award Survey Performed

10. Applicant's directly related experience to solicited items/services:

10 (a) If question 1 above is marked set-aside answer all that apply below.
•
•
•

Is this small business a Non-manufacturer?
Is this a Supply contract?
Has a NonManufacturer Rule Waiver been issued?

Yes
Yes
Yes

11. Percentage of Government contracts in relation to total sales over 3
years
Number of Employees

12.

Without
CoC Contract

No
No
No

%

Attach a list of all current commercial contracts and all
government contracts for past 3 years

With CoC
Contract

Hours of Work

Administrative and Management

No. of Shifts Hours

Production

per Shift Employees

Other

per Shift Days per

Without
CoC Contract

With CoC
Contract

Week
13. Are special skills required?

Yes

No

Are Employees w1th necessary skills available?

Yes

No

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Yes

No

FACILITlES AND EQUIPMENT

14.

Facility

Area in sq. ft.

List Machinery & Equipment required for this CoC Contract currently available.
List separately additional equipment to be acquired. Use separate sheet if
necessary.

Add'l. for CoC
Contract

Present

(1) Administrative
(2) Manufacturing
(3) Storage- inside
-outside
(4) Other- (specify)

Total
15. Give percentage (dollarwise) of inventory on hand for the proposed contract

%.

15a. Is the inventory proposed for this contract surplus inventory from another contract? __Yes

No

16. Total amount of dollars and percentage of dollars to be received from the Government under this contract and proposed to be subcontracted.
PLANT LOADING AND PRODUCTION SCHEDULES

17.

Total Projected Plant Load Chart (Use a separate line for each existing and proposed contract and each item of present and projected commercial
production. Show start and finish of each item by drawing a line between the month or week started and the month or week to be finished. Use
separate spread sheet if greater detail is needed to evaluate capacity.)
Schedule Periods are in

0 Weeks.

0 Months.
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

A. Commercial
B. Government
C. CoC Application Contract
D. Other
Present explanation for production and scheduling overlaps; explain delinquent contracts

COST ANALYSIS

18. Check basis

0

Unit Price,

0

Total Contract

Direct Material
Direct Labor g
Overhead
Subcontracting
G&A
SBA USE ONLY

19. Based on data contained in the foregoing and in the attached enclosures a CoC is

0 Recommended

0 Not Recommended

By

0 I Concur
0 I Do Not Concur (State reasons in items)

_

Signature

_
Reviewing
Official

Title
----------------------------

Date
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Title
Date

22

23

24

PART II
1. Name of Applicant

CoC Case#

3. Date Business Was Established

2. Type of Business (Check)
Individual Ownership
Partnership

Month

Year

Corporation

FINANCIAL STATEMENT
A.
Balance Sheet As Of

THE FOLLOWING MUST BE FILLED OUT OR ITS EQUIVALENT ATTACHED
, Fiscal Year Ends

----------------------------------

(Statement must be dated within 90 days_of the filing of this application. Omit $.00)

Audited or Unaudited:

Prepared By:
ASSETS

LIABILITIES

Cash on Hand and in Banks ---------------------

$

. $

Accounts Payable for Merchandise
Notes Payable- Payments Due Within One Year

* Notes Receivable ----------------------------*Accounts Receivable (Trade)
.$
Less Reserve for Doubtful Account_ .
Inventories (How valued- Cost ( ) or Market( )

To Banks ------------------------------For Merchandise ------------------------To Officers, Directors and Stockholders _ _ _ _

Finished ------------------ $

To Others -------------------------------

Stock in Process-------------

Mortgages Payable- Payments Due Within One Ye r
Contracts Payable- Payment Due Within One Year _

Raw Material---------------

*Accounts Due Officers or Stockholder
Accounts and Notes Due Affiliates ---------------Income Taxes - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - -

*Other Current Assets --------- --- ·-· ······-·- --Total Current Assets ------------------Cost
Depr.

Withholding and Other Taxes

Land
Buildings

*Other Accruals

Mach. & Equip.
F&F

*Other Current Liabilities -----------------------$
Total Current Liabilities

Autos & Trucks

Notes Payable- Payments Due After One Yea_r

Net Fixed Assets (Cost Less Depr.)_ - - - - - -- - - *Due from Affiliates or Subsidiaries ---------------* Due from Officers, Directors, and Stockholders

$

Mortgages Payable- Payments Due After One Year
Contracts Payable- Payments Due After One Yer
SBA Loan- Payments Due After One Year

Life Insurance (Cash Surrender Value)_
* Other Assets

------------------------------

*Other Liabilities ------------------------------

------------------------- - -- - - - - -

Total Liabilities ----------------------

$

Capital Stock Outstanding _ _ _ _ _ _ $
$
Earned Surplus
$
Capital Surplus
Total Assets

._.

Capital Account (If individual or partnership)
Total Liabilities and Net Worth

$

..

$

*ITEMIZE ON A SEPARATE SHEET ALL ITEMS MARKED WITH AN ASTERISK.
Contingent Liabilities: Accounts or notes receivable discounted or sold with endorsement or guarantee and all other contingent liabilities, including terms
of any leases, should be explained on a separate sheet. Also, describe any pending or imminent litigation, claims against U.S. Government or others.
Give present status.
Ageing

Accounts Receivable

Under 30 days

Accounts Payable

$

$

$

$

30- 60 days
60- 90 days
90- 120 days
Over 120 days
Uncollectible
Totals
Contracts,Notes and Mortgages Payable:
To Whom Payable

SBA Form 1531 (12-2017)

Original Amt.

Previous Editions Obsolete

Present
Balance

Rate of
Interest

Monthly
Payment

State Specific Sources for funds to finance this proposed contract:
(Attach letters of credit and/or your personal financial statements, if necessary)

COMPARATIVE STATEMENTS OF SALES, PROFIT OR LOSS, ETC. Detailed Profit and Loss statements Must Be Attached
Fiscal Year Ends (Give Date): MM/DD/YY

to date

If a Corporation, Use This Block:
Net Sales (Gross sales less returns and allowances)
Depreciation
Income Taxes
Compensation of Officers (Included in expenses)
Net Profit (After depreciation and Income Taxes)
Dividends Paid

to date

If a Partnership or Proprietorship, Use This Block:

Net Sales (Gross sales less returns and allowances
Depreciation
Withdrawals (For Income Taxes)
Personal Withdrawals by Owner or Partners
Net Profit (After depreciation and withdrawals)
B.

MANAGEMENT

Information to be furnished as to each officer, partner, or owner of applicant
Narne

%of Ownership

PART Ill

Net Worth Outside of Applicant

AGREEMENT

In order to comply with the provisions of Section 13of the Small Business Act, 15 U.S.C. , the applicant does hereby certify to and agree as follows:
A. In the event SBA issues the Certificate of Competency herein applied for, then for a period of two years from the date upon which such Certificate shall
have been issued, the applicant and its subsidiaries and affiliates agree to refrain from employing, tendering any offer of employment to, or retaining for
professional services, any person who, on such date, or within one year prior thereto, shall have served as an officer, attorney, agent, or employee of
SBA occupying a position or engaging in activities which SBA shall have determined involve discretion with respect to the granting of assistance under
the above Act
B. The names of all attorneys, accountants, appraisers, engineers, consultants, agents, or other persons engaged by or on behalf of the applicant for the
purpose of expediting this application or obtaining a Certificate of Competency and the fees and/or other compensation paid to such a person, are as
follows:
Name
Occupation
Address (Include Zip Code)
Compensation

C. The names of any members of the Small Business Administration National or Small Business Administration District Advisory Councils who have any direct
or indirect financial interest whatsoever in the applicant (such interest to include any direct or indirect financial interest in any other business entity or
enterprise which is, in any way, connected with the undersigned) are to the best of my knowledge, information, and belief as follows:
Name

Address (Include Zip Code)

D. To notify SBA in writing within five (5) days of any changes in items B and C above.
E. The applicant further agrees, in order to insure the continued recognition of the integrity of the SBA Certificate of Competency program if the Certificate
of Competency herein applied for is issued to permit authorized employees or representatives of SBA access to the applicant's financial, production, or
other business records and to the applicant's facilities at all reasonable times during the performance of the contract described in item 8.

Any documents that you provide as part of this request for a Certificate of Competency, including bid or proposal information or source selection information, are prohibited
from being released prior to the award of a contract. See, FAR § 3.104-3. After award of a contract, all information and/or documents may be disclosed but will be protected
to the fullest extent permitted by law, including the Privacy Act 5 U.S.C. § 552a and Freedom of Information Act, 5 U.S.C. § 552.
SBA Form 1531 (12-2017)

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PART IV -Certifications
By signing below, I hereby certify that all statements and all other information set forth on this form, and in all exhibits and documents submitted
with or in connection with this application are complete and accurate. I understand that the SBA is relying on the accuracy of this information in
determining whether to issue the Certificate of Competency (COC) and that issuance of the COC can entitle me and/or my company to obtain
future governmental payments or other benefits. WARNING: Any false information or misrepresentation regarding the accuracy and completeness
of the information provided may result in criminal, civil and/or administrative sanctions including, but not limited to: 1) fines of up to
$500,000 and imprisonment of up to 10 years, or both, under 18 U.S.C. § 1001, as well as penalties under other criminal laws; 2) treble damages
and civil penalties under the False Claims Act, 31 U.S.C. §§ 3729-3733; and 3) suspension and/or debarment from all Federal procurement and
non-procurement transactions.

Date
--------------------------------

Signature
NOTE: Corporate applicants must execute application in corporate name, by duly authorized officer, and partnership applicants must execute
application in firm name, together with signature of a general partner.
Section 16 of the Small Business Act, 15 U.S.C. 645, makes it a criminal offense punishable by fine of not more than $500,000 or by imprisonment
for not more than ten (10) years, or both, to make a statement knowing it to be false or make any misrepresentation to the Small Business Administration
for the purpose of influencing in any way the action of the Administration.
According to the Paperwork Reduction Act you are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. The
number for this collection is 3245-0225. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing and reviewing this
form is 2 hours per response. Comments or questions on the burden estimates should be sent to U.S. Small Business Administration, Chief, Records Management Division, , 409 3rd St.,
SW, Washington DC 20416 and/or SBA Desk officer, Office of Management and Budget, New Executive Office Bldg, Room 10202, Washington DC 20503 PLEASE DO NOT SUBMIT
COMPLETED FORMS TO OMB

SBA Form 1531 (12-2017)

Previous Editions Obsolete