36C25625R0079 EXHIBIT C.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C25625R0079
About this file
The document is a Subcontractor Information and Consent Form for a VA construction project (Solicitation No. 36C25625R0079) to abate floor mastic at Buildings 1 and 33 of the Overton Brooks VA Medical Center in Shreveport, Louisiana. The pre-solicitation notice is specifically targeted at Service-Disabled Veteran-Owned Small Businesses (SVOSBs), with a project cost range between $250,000 and $500,000 under NAICS code 238330 for Flooring Contractors.
Key requirements include mandatory SDVOSB certification through the SBA database, SAM registration, and compliance with VAAR 819.7003 and 852.219-75 eligibility criteria. The official solicitation will be issued on SAM.gov around 04/11/2025, with a planned site visit and requirement for a Bid Bond. The contract will be awarded using FAR 15.101-1 Tradeoff Process, and potential contractors must provide all labor, materials, tools, equipment, and expertise to complete the floor mastic abatement work as specified in the project's Scope of Work, Drawings, and Specifications.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-25-188 Abate Floor Mastic, Bldg 1 & Bldg 33 36C25625R0079
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. 36C25625R0079 for Project 667-25-188 (Abate Floor Mastic, Bldg 1 & Bldg 33) |
| 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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