36C25622R0146 EXHIBIT C.docx
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- Attached to
- Z2DA--Project #520-16-102 ER Structural and Foundation Problem, BLDG 3 - BXD (Construction) 36C25622R0146
- Solicitation number
- 36C25622R0146
About this file
This document is a subcontractor consent form and reference list template to be completed by major subcontractors proposed as part of a response to Solicitation Number 36C25622R0146 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The solicitation is for Project 520-16-102 ED Structural Repair in Biloxi, Mississippi and involves structural and foundation repair work to Building 3. Subcontractors must provide contact information, DUNS/Cage/SAM identifiers, and consent to allow their past performance information to be shared with the prime contractor for evaluation purposes during the source selection process. Subcontractors must also include a reference list with past contract details, roles, work performed, and points of contact for at least three references.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-16-102 ED Structural Repair 36C25622R0146
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. 36C25622R0146 for Project No. 520-16-102, ED Structural Repair |
| 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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