Attachment 5_ Surety Information.pdf

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104

Multiple Award Task Order Contract (MATOC) 36C24522R0056

SURETY FORM

OFFEROR INSTRUCTIONS: To be completed by Offeror and submitted to Surety requesting they complete and returned as indicated on Surety Instructions, no later than the closing date/time of this RFP.

Contractor Name: _____________________________________________________________

Address: ___________________________________________

Telephone: ___________________________________________

Please complete below and return as per instructions no later than: ______________

SURETY INSTRUCTIONS: To be completed by Surety and returned no later than the closing date/time of this RFP to:

Department of Veterans Affairs Network Contracting Office 5 Attn: Alison Klein Contract Specialist Mail : Louis A Johnson VAMC

1 Med Center Dr Clarksburg, WV 26301 or via e-mail to alison.klein@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? $______________________________

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:byran.burgee@va.gov