EXHIBIT C SUBCONTRACTOR INFORMATION AND CONSENT.docx

DOCX document 44 KB Posted

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Z2DA--Proj #: 629-18-127, Remodel Pharmacy for USP 800
Solicitation number
36C25621R0013
Issued by

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This document contains an exhibit and related federal contract opportunity. The exhibit is a subcontractor information and consent form for a project to renovate a pharmacy at a Veterans Health Administration facility in New Orleans to meet USP 800 requirements. It requests contact and past performance references from major subcontractors to assist with the prime contractor's proposal and performance assessment.

The related federal contract opportunity is a solicitation to provide supervision, labor, materials and equipment to remodel the pharmacy compounding area and build a segregated compounding area backup. It is set aside only for verified Service-Disabled Veteran-Owned Small Businesses and has a magnitude between $1 million to $5 million. The work is to be performed in New Orleans, Louisiana for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. Proposals are due from registered System for Award Management contractors by the unspecified date.

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Text version

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 36C25621R0013 Renovate Pharmacy for USP 800

EXHIBIT C – 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. In an effort to assist the Government in assessing your past performance relevancy we request that the following 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 past performance volume.

(NAME OF FIRM)

is currently planning on participating as a subcontractor and or a teaming partner with

(PRIME CONTRACTOR OR NAME OF ENTITY PROVIDING PROPOSAL)

in responding to the Request for Proposal No. 36C25621R0013 for Project 629-18-127 Renovate Pharmacy for USP 800.

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)(Title of Individual with authority to sign for and
Legally bind the company)

Company Name: Telephone #

Address:

City/State/Zip Code: Date:

Reference List (required):

1.Contract No. And Title:
Describe role (Prime/Sub) and work Performed:
Reference POC NamePhone:Fax:
Email address:
2.Contract No. And Title:
Describe role (Prime/Sub) and work Performed:
Reference POC NamePhone:Fax:
Email address:
3.Contract No. And Title:
Describe role (Prime/Sub) and work Performed:
Reference POC NamePhone:Fax:
Email address:

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