36C25218R0105-007.docx

Multiple Award Task Order Contract (MATOC) 36C25218R0105

Solicitation Attachment 5 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 this 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.

SAMPLE FORM:

__________________________ (Company name of Subcontractor or Teaming Partner) is currently planning on participating as a (Subcontractor or a Teaming Partner) with ____________________________ (prime contractor or name of entity providing proposal) for the Department of Veterans Affairs RFP Multiple Award Task Order Contract (MATOC) Solicitation 36C25218R0105.

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 as well as our recommended references as listed on the attachment.

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

Company Name: _____________________ Telephone #____________________

Address: ___________________________________________________________

Reference List (required and not to be from proposing prime contractor):

1. Contract No. __________________________________________________ Project No. and Title: ___________________________________________ Describe your role (Prime/Sub) and work Performed __________________ _____________________________________________________________ Reference POC Name_______________________ Phone_______________ Fax____________ Email address: ________________________________

2. Contract No. __________________________________________________ Project No. and Title: ___________________________________________ Describe your role (Prime/Sub) and work Performed __________________ _____________________________________________________________ Reference POC Name_______________________ Phone_______________ Fax____________ Email address: ________________________________

3. Contract No. __________________________________________________ Project 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 and 2nd tier subcontractors may be included and are encouraged.

SOURCE SELECTION SENSITIVE Page 1 of 2 Attachment 5

FAR 2.101 & 3.104-5