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This document includes a pre-solicitation notice for a Multiple Award Task Order Contract to provide construction period services for facility improvement projects at VA Medical Centers in Murfreesboro and Nashville, Tennessee. The Department of Veterans Affairs will award up to six firm-fixed price MATOC contracts to Service-Disabled Veteran-Owned Small Businesses through a lowest price technically acceptable source selection evaluating price, non-cost factors and past performance. Awardees will then compete for individual task orders over a one year base period and four one-year options. Services include various construction trades like mechanical, electrical, and carpentry work. The solicitation will be available on April 30, 2019 with responses due shortly after. Offerors must be registered in the Vendor Information Pages and SAM databases by the response deadline.

36C24919R0075 S02 ATTACHMENT D BONDING CAPACITY SURETY FORM.docx

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Text version

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 TVHS Multiple Award Task Order Contract (MATOC) 36C24919R0075 Attachment D

BONDING CAPACITY SURETY FORM

OFFEROR INSTRUCTIONS: To be completed by Offeror and submitted to Surety requesting they complete and return as indicated on Surety Instructions, by no later than the closing date/time of this RFP.

Contractor Name: _____________________________________________________________

Address:___________________________________________
___________________________________________
Telephone:___________________________________________

Please complete below and return as per instructions no later than: ______________

SURETY INSTRUCTIONS: To be completed by Surety and returned no later than the closing date/time of this RFP to:

Department of Veterans Affairs Network Contracting Office 09 Attn: Douglas J. Crowley, Contracting Officer Regular Mail : 1639 Medical Center Parkway Murfreesboro, TN 37129 or via e-mail to douglas.crowley@va.gov

FedEx:1639 Medical Center Parkway
Murfreesboro, TN 37129

Surety Name:__________________________________________________

Surety Address:___________________________________________
___________________________________________
Telephone: _________________________ Facsimile: _____________________

How long have you provided bonding for the above contractor? _________ YEARS What is the contractor’s rating? ________________________ Bonding Limit for a single project? $______________________________ Aggregate Bonding amount? $ ___________________________________________ Have you ever had to complete a project for the contractor? [ ] YES [ ] NO Has liability insurance ever been refused? [ ] YES [ ] NO Have there been complaints of non-payment by subcontractor/suppliers? [ ] YES [ ] NO Has the surety had to pay subcontractors/suppliers? [ ] YES [ ] NO

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