36C25625R0003 EXHIBIT E.docx

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Y1DZ--520-25-107 CON Repair JACC Chilled Water Piping (VA-24-00107298)
Solicitation number
36C25625R0003
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This document is a Surety Form for Solicitation 36C25625R0003, a contract opportunity with the Department of Veterans Affairs Veterans Health Administration for repair work on JACC Chilled Water Piping. The form requires detailed information from a surety company about their bonding relationship with a potential contractor, including the contractor's project rating, bonding limits, insurance history, and past performance. Key details include gathering information about the contractor's financial stability and reliability, with specific questions about project completion history, liability insurance, and subcontractor payment practices. The form is designed to be submitted as part of the technical proposal package, with sections for contractor and surety contact information, bonding capacity, and a series of yes/no assessment questions about the contractor's past performance.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 520-25-107 CON Repair JACC Chilled Water Piping 36C25625R0003

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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