36C25623R0039 EXHIBIT C.docx

DOCX document 26 KB Posted

Attached to
520-18-119 Install Photovoltaic Array, JACC Federal contract opportunity
Solicitation number
36C25623R0039
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

About this file

This document contains a subcontractor information and consent form template for the solicitation number 36C25623R0039 to install a photovoltaic array at the Joint Ambulatory Care Clinic in Pensacola, Florida. The form requires subcontractors to provide identifying information such as company name, DUNS number, and contact details. It also requests consent for the prime contractor to discuss the subcontractor's past performance with the government during the source selection process. Subcontractors must also provide a list of at least three past contract references that include the contract number, role on the contract as prime or subcontractor, work performed, and point of contact information for the reference.

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Text version

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-18-119 Install Photovoltaic Array 36C25623R0039

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. 36C25623R0039 for Project No. 520-19-118 Install Photovoltaic Array
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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