36C25622R0030 EXHIBIT C-Subcontractor Information and Consent Form .docx
DOCX document 26 KB Posted
- Attached to
- Z2FB--Biloxi MATOC-Seed Project Project #520-22-122 FCA Corrections BLDG 17 - 36C25622R0030
- Solicitation number
- 520-22-122
About this file
This document contains a subcontractor consent form template and information on a related federal contract opportunity for construction services. The consent form is to be completed by major subcontractors and teaming partners proposed by an offering contractor in response to Solicitation Number 520-22-122 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The solicitation seeks construction services for Project 520-22-122 FCA Corrections BLDG 17 and has an opportunity number of 36C25622R0030. The consent form allows the government to discuss a subcontractor's past and present performance with the prime contractor as part of the source selection process for the construction project.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-22-122 FCA Corrections BLDG 17-MATOC Seed Project 36C25622R0030
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. 36C25622R0030 for Project 520-22-122 FCA Corrections BLDG 17) |
| 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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