S02-657A4-21-800-ATTACHMENT 3-Surety Form.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
This is a surety form template that must be completed as part of solicitation 36C25525R0009 for HVAC infrastructure replacement work at the VA Medical Center in Poplar Bluff, Missouri. The form has two sections - one to be completed by the contractor/offeror and another by their surety company.
The form requires submission to the Department of Veterans Affairs Network Contracting Office 15 in Leavenworth, KS by January 16, 2025. The surety section requests information about the contractor's bonding history, including length of bonding relationship, contractor rating, single project and aggregate bonding limits, and whether there have been any issues with project completion, liability insurance, or payments to subcontractors/suppliers. The form is part of a larger SDVOSB set-aside solicitation estimated between $10-20 million for removing and replacing laboratory service HVAC systems and AC unit 9 with a 900-day period of performance.
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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 January 16, 2025
Contractor Name: ______________________________________________________ Address: _________________________________________________ Telephone: ___________________________________________ Please complete below and return as per instructions no later than: January 16, 2025.
SURETY INSTRUCTIONS: To be completed by Surety and returned no later than January 16, 2025 with proposal to:
Department of Veterans Affairs Network Contracting Office 15 Attn: Gislaine Dorvil, 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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