36C25623R0096 EXHIBIT C.docx
DOCX document 26 KB Posted
- Attached to
- Replace Chiller # 3 - Pineville, LA - VA (Project No. 502-21-110) Federal contract opportunity
- Solicitation number
- 36C25623R0096
About this file
This document contains a subcontractor consent form template for a federal contract opportunity with the Department of Veterans Affairs to replace a chiller at their facility in Pineville, Louisiana. Major subcontractors are requested to complete the form to consent to the release of their past performance information to the prime contractor, as part of the source selection process for solicitation number 36C25623R0096. The form requires the subcontractor's name, contact information, DUNS/Cage code, and signature of an authorized individual. It also includes a reference list for the subcontractor to provide details of up to three relevant past contracts, including contract number and title, their role as prime or subcontractor, work performed, and points of contact for each reference.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25623R0096 0004.docx | DOCX document | |
| 36C25623R0096 0003.docx | DOCX document | |
| Attachment 1A00002 - 2023-08-18 Addendum No. 1.pdf | ||
| 36C25623R0096 0002.docx | DOCX document | |
| Attachment 2A00002 236400 3-20 Packaged Water Chillers - Addendum 1.pdf | ||
| 36C25623R0096 0001.docx | DOCX document | |
| 36C25623R0096 - Site Visit Sign in Sheet 502-21-110 Aug 15 23.jpg | JPG image | |
| 36C25623R0096 EXHIBIT E.docx | DOCX document | |
| PRA 502-21-110 Chiller 3 Replacement - Copy.pdf | ||
| DBA WD LA20220041 Mod 5 (6-16-23).pdf | ||
| 36C25623R0096.docx | DOCX document | |
| 36C25623R0096 EXHIBIT F.docx | DOCX document | |
| Final SOW - Formatted.docx | DOCX document | |
| 36C25623R0096 EXHIBIT A.docx | DOCX document | |
| 36C25623R0096 EXHIBIT B.docx | DOCX document | |
| 36C25623R0096 EXHIBIT D.docx | DOCX document | |
| 36C25623R0096 Design Analysis.pdf | ||
| 36C25623R0096 Drawings.pdf | ||
| 36C25623R0096 Specifications.pdf |
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 502-21-110 Replace Chiller # 3 36C25623R0096
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. 36C25623R0096 for Project 502-21-110 Replace Chiller # 3) |
| 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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