36C10E19R0003-005.doc

EXHIBIT C

IDIQ VICCS

RFP No. 36C10E19R0003

EXHIBIT C – SUBCONTRACTOR INFORMATION AND CONSENT FORM

Subcontractor and/or Teaming Partner Consent for the Release of Past Performance Information to the Prime Contractor and Reference Information

Past performance information concerning subcontractors and teaming partners cannot be disclosed to a private party without the subcontractor’s or teaming partner’s consent. Because a prime contractor is a private party, the Government will need that consent before disclosing subcontractor/teaming partner past and present performance information to the prime during exchanges. In an effort to assist the Government in assessing your past performance relevancy we request that the following consent form be completed by the major subcontractors/teaming partners identified in your proposal. The completed consent forms should be submitted by the offering contractor for submission with the past performance volume.

_________________________________________________(Name of Firm) is currently planning on participating as a (subcontractor and or a teaming partner) with _________________________________________________(prime contractor or name of entity providing proposal) in responding to the Request for Proposal No. 36C10E19R0003 for a Multiple Award Indefinite-Delivery Indefinite-Quantity (IDIQ) contract for all services required under the Veterans Intake, Conversion, and Communications Services (VICCS) program, for the VBA Office of Business and Process Integration (OBPI).

We, the subcontractor and/or teaming partner, understand that the Government is placing increased emphasis on past performance to obtain best value in source selections. In order to facilitate the performance risk assessment process we are signing this consent form to allow you to discuss our past and present performance information with the prime contractor during the source selection process.

Company Name:

Address:

City/State/Zip Code:

Telephone:

Reference List (required):

1. Contract Specifics

Description of Effort as ___________Prime or _________Subcontractor

Contract Number _____________________

Contract $ Value _____________________ Reference Point of Contact Information (Name, Title, Phone, Email) Description of the work performed under the contract (Use as much space as necessary)

2. Contract Specifics Description of Effort as ___________Prime or _________Subcontractor

Contract Number _____________________

Contract $ Value _____________________ Reference Point of Contact Information (Name, Title, Phone, Email) Description of the work performed under the contract (Use as much space as necessary)

3. Contract Specifics Description of Effort as ___________Prime or _________Subcontractor

Contract Number _____________________

Contract $ Value _____________________ Reference Point of Contact Information (Name, Title, Phone, Email) Description of the work performed under the contract (Use as much space as necessary)

Contractor

By signing below, it is understood that the Government may discuss our past and present performance information with the prime contractor during the source selection process.

Name:

Title:

Signature:

Date: