36C25621R0109 EXHIBIT C.docx
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- Attached to
- Z1DZ-- Proj No 520-22-113 Access Control &Security Systems Upgrade Federal contract opportunity
- Solicitation number
- 36C25621R0109
About this file
This document contains a subcontractor consent form and details of a federal contract opportunity for access control and security system upgrades. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 is seeking proposals for Project 520-22-113 to upgrade access control and security systems at the Gulf Coast Veterans Health Care System in Biloxi, Mississippi under solicitation number 36C25621R0109. The procurement will be set aside 100% for Service-Disabled Veteran-Owned Small Businesses. Proposals are due around September 6, 2021 with contract award anticipated within 30 days thereafter. The performance period is 180 days from notice to proceed. The estimated value is between $1,000,000 and $2,000,000. Offerors must be verified in the Vendor Information Pages database and registered in the System for Award Management. Subcontractors must complete the consent form to allow disclosure of past performance information to prime contractors.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project 520-22-113 Access Control & Security System Upgrades 36C25621R0109
EXHIBIT C – 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 the following 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.
Name of Firm: _________________________________
| (That is currently planning on participating as a subcontractor and or a teaming partner with) |
| Telephone:______________ |
Address:________________
City/State/Zip Code:_______
DUNS/Cage Code:__________________
Name of Prime:__________________________________
| (PRIME CONTRACTOR OR NAME OF ENTITY PROVIDING PROPOSAL in responding to the Request for Proposal No. 36C25621R0109 for Project 520-22-113 Access Control & Security System Upgrades) |
| Telephone:__________________ |
Address:____________________
City/State/Zip Code:___________
DUNS/Cage Code:____________
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.
| Signature:___________________________________ |
| ___________________________ |
Title of Individual with authority to sign for and Legally bind the company
Reference List (required):
Contract No. And Title:
Describe role (Prime/Sub) and work Performed
Reference POC Name
Email address & Phone #
Contract No. And Title:
Describe role (Prime/Sub) and work Performed
Reference POC Name
Email address & Phone #
Contract No. And Title:
Describe role (Prime/Sub) and work Performed
Reference POC Name
Email address & Phone #
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