36C25625R0067 EXHIBIT C.docx
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- Solicitation number
- 36C25625R0067
About this file
This document is a Subcontractor Information and Consent Form for a Department of Veterans Affairs project (Solicitation No. 36C25625R0067) involving roof and window replacement at Building 4. The form serves to obtain consent from potential subcontractors or teaming partners to release their past performance information to the prime contractor during the source selection process, which is critical for the government's best value assessment.
The solicitation requires subcontractors to complete a detailed consent form that includes company information, reference contracts, and authorization for performance information disclosure. The project, identified as Project 502-21-118, is being conducted by the Veterans Health Administration's Veterans Integrated Service Network 16, with the specific scope involving replacement of roof and windows for Building 4. Subcontractors must provide contract references, including contract numbers, roles, work performed, and point of contact information to support the past performance evaluation.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 502-21-118 Replace Roof and Windows of Bldg 4 36C25625R0067
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. 36C25625R0067 for Project 502-21-118 (Replace Roof and Windows of Bldg 4) |
| 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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