36C77018R0359-006.pdf

Department of Veterans Affairs Network Contracting Office (NCO) 15

CMOP Acquisitions 3450 South 4th Street Trafficway

Leavenworth, KS 66048

We are currently participating as a (subcontractor/teaming partner) with _______________ (prime contractor or name of entity providing proposal) in responding to the Department of Veterans Affairs CMOP Acquisitions request for Proposal 36C77018R0359 for the Shipper/Packer requirement.

We understand that the Government is using past performance as evaluation criteria 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, if it becomes necessary.

(Signature and Title of individual who has the authority to sign for and legally bind the partnering company)

Company Name:

Address:

DUNS:

Phone Number:

E-mail Address: