EXHIBIT B - Subcontractor Consent and Reference Form B1 2E Clinics 12.12.2023.pdf

EXHIBIT B – SUBCONTRACTOR CONSENT AND REFERENCE FORM

PART 1 - INSTRUCTIONS:

Subcontractor and/or Teaming Partner Consent for the release of Past Performance Information including references to the Prime Contractor:

Each Subcontractor and/or Teaming Partner named by the Offeror in Exhibit A, Part 2 must complete an Exhibit B - Subcontractor Consent and Reference Form to be considered.

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 Performance information to the Prime during exchanges.

Two (2) Subcontractor’s references are also required to be completed on this form. Separate written references for Subcontractors may also be included and are encouraged; however, Subcontractors do not need to send out Past Performance Questionnaires to references included only on this form. Subcontractor may attach associated written references to this form.

Offeror may elect to have Subcontractors also submit Relevant Prior Project Experience on up to one (1) Exhibit A, Part 1 form. Projects described on Exhibit A forms shall have Past

Performance Questionnaires (PPQs) sent to associated reference contacts regardless of Prime

(Offering) or Sub Contractor status. Offeror cannot be a POC for a Subcontractor on the

Exhibit A form, and cannot be a written reference in Exhibit B.

The completed consent forms with any reference attachments shall be submitted to the

Offering Prime Contractor for submission in the proposal.

PART 2 - SUBCONTRACTOR CONSENT:

(name of subcontracted firm) is currently planning on participating as a Subcontractor and or Teaming Partner with (Prime Contractor or name of entity submitting proposal) in responding to the Request for Proposal Number 36C24424R0015

Project 646-14-102 “Renovate B1 2E for Clinic” VA Pittsburgh Healthcare System

(VAPHS) at University Drive Division, Pittsburgh, PA 15240, issued by the VAPHS, 1010

Delafield Road, Pittsburgh, PA 15215, Contract Specialist – John Mignogna

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 proposal review and evaluation process, we are signing this consent form to allow the Government to discuss our Past

Performance information with the Prime Contractor during the source selection process.

(Signature) (Title, Company of Individual with authority to sign for and legally bind the company)

Address:

City/State/Zip Code: Date:

PART 3 - SUBCONTRACTOR’S REFERENCE LIST (REQUIRED):

1. Project Title and Contract No.

Describe your role (Prime/Sub) and work performed:

Reference POC Name, Title, Organization:

Phone: Email Address:

2. Project Title and Contract No.

Describe your role (Prime/Sub) and work performed:

Reference POC Name, Title, Organization:

Phone: Email Address: