36C25622R0123 EXHIBIT C.docx
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- Attached to
- Z1DA--Project #520-22-174 Access Control and Security System Upgrades and Misc Interior Improvements-Construction - 36C25622R0123 Federal contract opportunity
- Solicitation number
- 520-22-174
About this file
This document contains a subcontractor information and consent form template for use in proposal submissions for solicitation number 520-22-174 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The form requires subcontractors and teaming partners to provide contact information and consent to the release of their past performance information to the prime contractor for evaluation purposes during the source selection process. Subcontractors must also include a reference list with at least three past contracts describing their role and work performed, along with points of contact from those references including name, email, phone and contract information. This will facilitate the government's assessment of past performance as it places increased emphasis on best value in making its source selection determination.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-22-174 Access Control, Security System Upgrades & Miscellaneous Interior Improvements 36C25622R0123
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. 36C25622R0123 for Project #520-22-174) |
| 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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