SUBCONTRACTOR INFORMATION AND CONSENT FORM.docx

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 626A4-19-101 - Renovate Ward 1B 36C24923R0114

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 to the offering contractor for submission with 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 (RFP) 36C24923R0114 to 626A4-19-101 - Renovate Ward 1B at the Alvin C. York VA Medical Center.

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 and not to be from proposing prime contractor):

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: ________________________________________________________

Each major subcontractor and or Teaming Partner must complete the “Subcontractor Information and Consent Form” to be considered. Offerors shall have major subcontractors identify at a minimum three (3) references, owners (if they were the Prime) or other Prime contractors they have worked for. References for subcontractors from the proposing offeror are not acceptable. Written references for subcontractors may be included and are encouraged.