36C24418R0274-004.docx

EXHIBIT B – 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 shall be submitted to 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 Number 36C24418R0274 for the Create Clinical Space Bldg. 18 to be performed at the Department of Veterans Affairs, Lebanon VA Medical Center, Lebanon, Pennsylvania.

We understand that the Government is placing increased emphasis on past performance in order to obtain best value in source selections. In order to facilitate the performance confidence 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.

(Signature) (Title of Individual with authority to sign for and legally bind the company)

Company Name: ________________________ Telephone #____________________

Address: ______________________________

City/State/Zip Code:______________________ Date:_____________________

Reference List (required):

1. Contract No. And Title___________________________________________________________ Describe your role (Prime/Sub) and work Performed ___________________________________ Reference POC Name____________________________ Phone___________ Fax____________ Email address: _________________________________________________________________

2. Contract No. And Title___________________________________________________________ Describe your role (Prime/Sub) and work Performed ___________________________________ Reference POC Name____________________________ Phone___________ Fax____________ Email address: _________________________________________________________________

3. Contract No. And Title___________________________________________________________ Describe your role (Prime/Sub) and work Performed ___________________________________ Reference POC Name____________________________ Phone___________ Fax____________ Email address: _________________________________________________________________