Attachment 6 - Surety Form - 515-24-500.doc
DOC document 72 KB Posted
- Attached to
- Z1DA--Battle Creek JOC IDIQ 515-24-500
- Solicitation number
- 36C25025R0070
About this file
The document is a Surety Form for a Job Order Contract (JOC) Indefinite Delivery Indefinite Quantity (IDIQ) solicitation for the Department of Veterans Affairs at the Battle Creek VA Medical Center in Michigan. The form is designed to gather critical financial and performance information about a contractor's bonding capacity and historical performance from their surety provider.
The solicitation (36C25025R0070) requires the surety to disclose key details such as the contractor's bonding rating, single project bonding limit, aggregate bonding amount, and past performance history. The form seeks to verify the contractor's financial stability by asking whether the surety has ever completed a project for the contractor, been refused liability insurance, encountered subcontractor payment complaints, or had to directly pay subcontractors. The completed form must be emailed to terrance.deininger@va.gov, indicating it is part of the pre-award evaluation process for this VA construction or renovation project.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information – See FAR 2.101 & 3.104 Indefinite Delivery Indefinite Quantity (IDIQ) – Job Order Contract (JOC) Solicitation#: 36C25025R0070
SURETY FORM
OFFEROR INSTRUCTIONS: To be completed by Offeror and submitted to Surety requesting they complete and return as indicated on Surety Instructions:
Contractor Name:
Address: ______________________________________________________ Telephone: ______________________________________ Email: ______________________________________
SURETY INSTRUCTIONS: To be completed by Surety and emailed to: terrance.deininger@va.gov
Surety Name:
Surety Address:
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
Signature of Provider: ____________________________________
Title: ______________________ Date: _______________
File details come from the government source that posted it. Updated .