36C25519R0054-005.docx

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36C25519R0054 MARION JOC Federal contract opportunity
Solicitation number
36C25519R0054
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15

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36C25519R0054 Attachment_3_-_Surety_Form.docx

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Indefinite Delivery Indefinite Quantity – Job Order Contract (JOC) 36C25519R0054

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 June 3, 2019

Contractor Name: _____________________________________________________________

Address:___________________________________________
___________________________________________
Telephone:___________________________________________

Please complete below and return as per instructions no later than: June 3, 2019.

SURETY INSTRUCTIONS: To be completed by Surety and returned no later than June 3, 2019 to:

Department of Veterans Affairs Network Contracting Office 15 Attn: David P. Holden, Contracting Officer Regular Mail: 3450 S 4th Street

Leavenworth KS 66048or via e-mail to Jeanette.Mathena@va.gov
FedEx:3450 S 4th Street TrafficwayJames.Petrik@va.gov
Leavenworth KS 66048

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 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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