36C25519R0051-004.docx

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Indefinite Delivery Indefinite Quantity – Job Order Contract (JOC) 36C25519R0051

ATTACHMENT 3

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 March 28, 2019

Contractor Name: _____________________________________________________________

Please complete below and return as per instructions no later than: March 28, 2019.

SURETY INSTRUCTIONS: To be completed by Surety and returned no later than March 28, 2019 with proposal to:

Department of Veterans Affairs Network Contracting Office 15 Attn: Jeanette Mathena, Contracting Officer Regular Mail: 3450 S 4th Street Trafficway Leavenworth KS 66048 or via e-mail to Jeanette.Mathena@va.gov

Surety Name:__________________________________________________

How long have you provided bonding for the above contractor? _________ YEARS What is the contractor’s rating? ________________________ Bonding Limit for a single project? $______________________________ Aggregate 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