Attachment 10 - Subcontractor Past Performance Consent Form (1 page).pdf

PDF 81 KB Posted

Attached to
Y1DB--Expand Interventional Radiology Suite Federal contract opportunity
Solicitation number
36C24823R0162
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

About this file

This document contains a consent form template for subcontractors and teaming partners to allow disclosure of their past performance information to prime contractors for a Department of Veterans Affairs solicitation. The consent form requests the subcontractor or teaming partner's company name, signature and title of an authorized individual, contact information, and DUNS number. It authorizes the prime contractor to discuss the subcontractor or partner's past and present performance with the Government during the source selection process for solicitation number 36C24823R0162 for expanding an interventional radiology suite.

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SOLICITATION ATTACHMENT

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 (if any). In an effort to assist the Government in assessing your past performance relevancy we request that this 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 technical proposal.

SAMPLE FORM:

__________________________ (Company name of Subcontractor or Teaming Partner) is currently planning on participating as a (Subcontractor or a Teaming Partner) with ____________________________ (prime contractor or name of entity providing proposal) for the Department of Veterans Affairs, Solicitation #:________________.

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) / (Date) (Title of Individual with authority to sign for and legally bind the company)

Company Name: _____________________ Telephone #____________________

DUNS #: ___________________________ Email: ________________________

Address: ___________________________________________________________

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