36C25622R0088 EXHIBIT E.docx

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Z2LZ--Project #629-18-115 Install Signs and Striping for Garages - Construction
Solicitation number
36C25622R0088
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This document contains a surety form for a federal contract opportunity with the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The solicitation is for Project 629-18-115 to install signs and striping for garages. Offerors are required to submit the completed surety form as part of their technical proposal package. The surety form requests information from the offeror's surety including bonding limits, claims history, and refusal of liability insurance. It seeks to ascertain the surety's experience with and evaluation of the offeror.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project 629-18-115 36C25622R0088

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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