36C25625R0082 EXHIBIT E.docx

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Z2DA--Project 667-25-190 Install Isolation Valves, B1 (Con)
Solicitation number
36C25625R0082
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This document is a Surety Form for a Department of Veterans Affairs contract (Solicitation Number 36C25625R0082) related to installing isolation valves on the domestic water system in Building 1 at a VA facility. The form is designed to be completed by a surety company and submitted as part of the technical proposal package, requiring detailed information about the contractor's bonding history, financial capacity, and past performance.

Key details include a request for the surety to disclose their bonding relationship with the contractor, including years of service, contractor rating, single project bonding limit, and aggregate bonding amount. The form also requires the surety to confirm whether they have ever completed a project for the contractor, been refused liability insurance, experienced complaints of non-payment from subcontractors/suppliers, or had to directly pay subcontractors/suppliers. The solicitation is issued by the Veterans Health Administration's Veterans Integrated Service Network 16, with the project number 667-25-190, indicating a specific infrastructure improvement project at a VA healthcare facility.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 667-25-190 Install Isolation Valves on Domestic Water System, BLDG 1 36C25625R0082

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

File details come from the government source that posted it. Updated .