657A4-21-800-ATTACHMENT 3-Surety Form_Rv.pdf
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- Attached to
- Z2DA--657A4-21-800, TF - FCA - Remove and Replace End-of-Life HVAC Infrastructure Building 1
- Solicitation number
- 36C25525R0009
About this file
The document is a Surety Form (Attachment 3) for a Department of Veterans Affairs contract opportunity (Solicitation Number 36C25525R0009) for removing and replacing end-of-life HVAC infrastructure at Building 1 of the John J. Pershing VA Medical Center in Poplar Bluff, Missouri. The form requires both the contractor and surety to complete specific sections, with a submission deadline of April 15, 2025. The surety must provide details including years of bonding experience, contractor rating, bonding limits, and answer critical questions about the contractor's performance history, such as project completions, insurance refusals, and payment complaints.
This procurement is set aside exclusively for Service-Disabled Veteran-Owned Small Businesses (SDVOSB), with an estimated project cost between $10-20 million and a 900-calendar-day performance period. The project involves general construction services for removing and replacing the Laboratory Service HVAC System and AC 9 in various facility areas, including ground floor, dental, admin suite, and laundry. The contract will be awarded using a Best Value Lowest Price Technically Acceptable Source Selection Process, with the solicitation package expected to be available for download by December 9, 2024.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104
657A4-21-800 TF - FCA - Remove and Replace End-of-Life Heating, Ventilation and Air Conditioning Infrastructure Building 1
36C25525R0009
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 April 15, 2025
Contractor Name: ______________________________________________________ Address: _________________________________________________
Telephone: ___________________________________________ Please complete below and return as per instructions no later than: April 15, 2025.
SURETY INSTRUCTIONS: To be completed by Surety and returned no later than April 15, 2025 with proposal to:
Department of Veterans Affairs Network Contracting Office 15 Attn: Arnold Payne, Contract Specialist Regular Mail: 3450 S 4th Street Trafficway
Leavenworth KS 66048 or via e-mail to Lucia.Cowsert@va.gov
FedEx: 3450 S 4th Street Trafficway 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 mailto:Gislaine.Dorvil@va.gov
| Attachment 3 |
| SURETY FORM |
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