36C25622R0141 EXHIBIT C R1.docx
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- Solicitation number
- 36C25622R0141
About this file
This document contains a subcontractor consent form template for a federal project to upgrade mechanical systems. The form requires subcontractors to provide identifying information and consent to the release of their past performance information to the prime contractor responding to Solicitation Number 36C25622R0141 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. Subcontractors must include their name, address, phone number, DUNS/Cage/SAM codes, describe the work performed and references including contract number, role, point of contact name, email, and phone number. The consent allows the prime contractor to discuss subcontractor past and present performance with the government during source selection for Project Number 520-22-167.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-22-167 Upgrade Mechanical Systems 36C25622R0141
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/SAM Unique Identifier Codes:_________________
Name of Prime:__________________________________
| (PRIME CONTRACTOR OR NAME OF ENTITY PROVIDING PROPOSAL in responding to the Request for Proposal No. 36C25622R0141 for Project No.520-22-167 Upgrade Mechanical Systems |
| Telephone:________________ |
Address:__________________
City/State/Zip Code:___________
DUNS/Cage/SAM Unique Identifier Codes:____________
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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