36C25622R0067 EXHIBIT E R1.docx
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- Solicitation number
- 667-22-4-1404-0033
About this file
This document contains an exhibit form for a surety bond and information on a related federal contract opportunity for repair of a water distribution system at a Veterans Affairs medical center. The opportunity is solicited under solicitation number 667-22-4-1404-0033 for project number 667-18-119. It is a 100% service-disabled veteran-owned small business set-aside to upgrade the water distribution system at the main hospital in Shreveport, Louisiana. Offerors must be registered in the System for Award Management and Vendor Information Pages databases and meet a $39.5 million size standard under NAICS code 236220. The agency is the Veterans Health Administration within the Department of Veterans Affairs Veterans Integrated Service Network 16. The surety form must be completed by the surety and submitted as part of the technical proposal. It requests information on bonding limits, claims history, and relationship with the contractor.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-18-119 Repair Water Distribution System – Main Hospital 36C25622R0067
EXHIBIT E
SURETY FORM
OFFEROR INSTRUCTIONS: To be completed by Surety and SUBMITTED BY OFFEROR AS A PART OF THE TECHNICAL PROPOSAL PACKAGE.
Contractor Name:
Address:
Telephone: Email:
Please complete below and return no later than:
Surety Name:
Surety Address:
| POC: | Title: | |
| Telephone: | Email: |
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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