SBA Form 1531 APPLICATION FOR CERTIFICATE OF COMPETENCY

Control No. 3245-0225
Exp. Date: 01-31-2021

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, https://www.sba.gov/node/4808
Basis of Referral:
Capacity

PART I

Credit

Other

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

Explain:

___________________________________________________________________
Solicitation Number

Procurement Designation
Set-Aside

or Unrestricted

2. Next Apparent Successful Offeror-- Whether large or small business, price difference.

3. Name and Address of Contracting Agency

Contract Specialist
Phone Number
Email
Contracting Officer
Email

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

County:

Email Address:

County:

Contact Name:

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

SBA Form 1531 (03/2021) Previous Editions Obsolete

Total Offered Price
Progress Payments
Available?

Functions at Location

Email:

Yes

Unit Price, if applicable

d.
e.

Website:

8. Brief Description of Solicited Items or Services

9b. Was Pre-award Survey Conducted?

Increase Option

C.

Title

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

7. Telephone No. (Include Area Code)

Quantity

b.

Principal Company Officials (Attach Resumes)
Name

5. Telephone No. (Include Area Code)

a.

No If yes, date of Pre-award Survey Performed

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

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

Is this small business a Nonmanufacturer?

Yes

No

•

Is this a supply contract?

Yes

No

•

Has a Nonmanufacturer Rule waiver been issued?

Yes

No

11b. Attach a list of all current commercial contracts and all government

11a. Percentage of Government contracts in relation to total sales over 3

contracts for past 3 years

years _____________%
Without
COC Contract

Number of Employees

12.

With COC
Contract

Hours of Work

Administrative and Management

No. of Shifts

Production

Hours per Shift

Other

Employees per Shift

Total

Total labor hours per Week

13a. Are special skills required?

Yes

No

13b. Are employees with necessary skills available?

Yes

No

14. Facility Area in sq. ft.

Present

(1) Administrative
(2) Manufacturing
(3) Storage - inside
-outside

(4) Other- (specify)
Total

SBA Form 1531 (03/2021) Previous Editions Obsolete

Add ‘l. for COC
Contract

Without
COC Contract

With COC
Contract

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

FACILITIES AND EQUIPMENT
15a. Give percentage(dollar-wise) of inventory on hand for the proposed contract

%.

15b. Is the inventory proposed for this contract surplus inventory from another contract? Yes

No

16a. Total amount of proposed contract paid by the Government to be subcontracted $_____________

_____%

16b. Total amount of proposed contract paid by the Government to be subcontracted to firms that are not similarly situated $ _____________ _______%

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 Months

1

Weeks

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

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 Unit Price

Total Contract

Direct Material

Other(Specify)

Direct Labor
Overhead
Subcontracting

Profit

G&A

Total

SBA USE ONLY
19. Based on data contained in the foregoing and in the attached enclosures a COC is
Recommended

Not Recommended

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

By
Signature
Title
Date

SBA Form 1531 (03/2021) Previous Editions Obsolete

Reviewing
Official
Title and Date _____________________________________________

PART II
COC Case #

1. Name of Applicant

2. Type of Business (Check)
Individual Ownership
Partnership
Corporation

3. Date Business Was Established

Joint Venture
Cooperative
Other

Month

(Explain)

Year

FINANCIAL STATEMENT

A.

Balance Sheet As Of
or

Audited

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)

Unaudited

Prepared By:

ASSETS

LIABILITIES
$

Cash on Hand and in Banks
*Notes Receivable
$
*Accounts Receivable (Trade)
Less Reserve for Doubtful Accounts
or Market
Inventories (How valued - Cost
$
Finished

Notes Payable - Payments Due Within One Year
To Banks
For Merchandise

)

To Officers, Directors and Stockholders
To Others

Stock in Process
Raw Material

Mortgages Payable - Payments Due Within One Year
Contracts Payable - Payment Due Within One Year

* Other Current Assets

* Accounts Due Officers or Stockholders

Total Current Assets
Cost
Land

Accounts and Notes Due Affiliates

Depr.

Income Taxes
Withholding and Other Taxes

______________ _______________

Buildings

$

Accounts Payable for Merchandise

_______________

* Other Accruals
* Other Current Liabilities
Total Current Liabilities

Mach. & Equip.
Furniture & Fixture
Autos & Trucks
Net Fixed Assets (Cost Less Depr.)
* Due from Affiliates or Subsidiaries

$

Notes Payable - Payments Due After One Year
Mortgages Payable - Payments Due After One Year

$

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

* Due from Officers, Directors, and Stockholders

* Other Liabilities

Life Insurance (Cash Surrender Value)
* Other Assets

$

Total Liabilites

$
$
$ ______________

Capital Stock Outstanding
Earned Surplus
Capital Surplus

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.
Aging
Accounts Receivable
Accounts Payable
Total Assets

Under 30 days

$

$

$

$

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

Original Amt.

Present
Balance

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

SBA Form 1531 (03/2021) Previous Editions Obsolete

Rate of
Interest

Maturity

Monthly
Payment

Security

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

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
Name

% of Ownership

PART III

Net Worth Outside of Applicant

AGREEMENT

In order to comply with the provisions of Section 13, 15 U.S.C 642 of the Small Business Act, 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 his 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 any person, are as follows:
Name
Occupation
Address (Include Zip Code)
Compensation

C. The names of any members of the National or District Small Business Advisory Council 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.
F. 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 (03/2021) Previous Editions Obsolete

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 nonprocurement 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 (03/2021) Previous Editions Obsolete