36C25622R0073 EXHIBIT C.docx
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- Attached to
- Z1DZ--Project# 502-20-113 Building 9 - 3rd Floor Anti-Ligature Renovations - Construction
- Solicitation number
- 36C25622R0073
About this file
This document contains a subcontractor consent form and reference list for a federal construction project solicitation. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 is soliciting proposals for Project #502-20-113 to renovate the third floor of Building 9 for anti-ligature improvements at an unspecified location. Prime contractors must submit completed consent forms from major subcontractors to allow the government to discuss past performance with the prime during source selection for the construction work. Subcontractors provide their contact information, consent to discuss performance, and list at least three past contracts including the role performed and a reference point of contact for each.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 502-20-113 BLDG 9 – 3rd Floor Anti-Ligature Renovations 36C25622R0073
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. 36C25622R0073 for Project 502-20-113 BLDG 9 – 3rd Floor Anti-Ligature Renovations) |
| 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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