36C25623R0012 EXHIBIT E.docx
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- 36C25623R0012 - 520-22-178-Z1DZ--CON Correct FCA Deficiencies related to Project No. 520-22-178
- Solicitation number
- 36C25622R0012
About this file
This document contains a surety form and information on a related federal contract opportunity. The surety form requests information from a surety company about a contractor's bonding history, limits, and claims experience. It must be submitted as part of the technical proposal for solicitation number 36C25623R0012 from the Department of Veterans Affairs Veterans Health Administration. This is a re-solicitation for project number 520-22-178 to correct deficiencies at a federal facility. The opportunity is set aside 100% for veteran-owned small businesses. Responses are due by the date specified on the surety form.
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FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-22-178 Correct FCA Deficiencies 36C25623R0012
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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