36C25626R0117 EXHIBIT E Surety Form.docx

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Y1PZ--Project 629-25-104 ED Suicide Risk Mitigation Fence
Solicitation number
36C25626R0117
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This is a Surety Form template that offerors must complete and submit as part of their technical proposal package for the Department of Veterans Affairs Veterans Health Administration (VISN 16) project involving a suicide risk mitigation fence (Project No. 629-25-104, Solicitation 36C25626R0117).

The form requires the selected surety to provide information about their bonding relationship with the contractor, including the duration of the bonding relationship, the contractor's rating, bonding limits for single projects and aggregate amounts, and relevant claims history. Specifically, the surety must disclose whether they have previously completed a project for the contractor, whether liability insurance has been refused, whether complaints of non-payment from subcontractors or suppliers have been filed, and whether the surety has had to pay subcontractors or suppliers on the contractor's behalf. The form is completed by the surety but must be submitted by the offeror as part of the technical proposal package, with completion required by a deadline specified in the solicitation documents.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 629-25-104 36C25626R0117

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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