Attachment 16 - Surety Form.pdf

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104

Indefinite Delivery Indefinite Quantity

ATTACHMENT 16

SURETY FORM

OFFEROR INSTRUCTIONS: To be completed by Offeror and submitted to Surety requesting they complete and return as indicated on Surety Instructions, by no later than July 27,2022 at 0900.AM

Contractor Name: _____________________________________________________________

Address: ___________________________________________

Telephone: ___________________________________________

Please complete below and return as per instructions no later than: 27 Jul 2022, NLT 0900 AM

SURETY INSTRUCTIONS: To be completed by Surety and returned no later than July 27, 2022, NLT to 0900 AM:

Department of Veterans Affairs Network Contracting Office 08 Attn: Apolinar Vargas at apolinar.vargas@va.gov

Surety Name:__________________________________________________

Surety Address: ___________________________________________

Telephone: _________________________ Facsimile: _____________________

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 mailto:yvonne.demorest@va.gov