EXHIBIT C SUBCONTRACTOR INFORMATION AND CONSENT.docx
DOCX document 44 KB Posted
- Solicitation number
- 36C25621R0054
About this file
This document contains an exhibit and related federal contract opportunity. The exhibit is a subcontractor information and consent form for a medical gas expansion project at Building 15 at Biloxi, Mississippi. Major subcontractors are required to complete the form to consent to the release of their past performance information to the prime contractor.
The related federal contract opportunity is a 100% set-aside solicitation for service-disabled veteran-owned small businesses to provide all labor, materials and equipment for the medical gas expansion project at the Gulf Coast Veterans Health Care System in Biloxi. Interested offerors must check the SAM.gov website for the solicitation number 36C25621R0054 and any amendments. Proposals are due around February 26, 2021 with an anticipated award date around 30 days later. The performance period is 150 days from notice to proceed. The project construction cost is between $500,000 to $1 million. Offerors must meet SDVOSB and small business size standards and be registered in the Vendor Information Pages and SAM databases.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project 520-22-162 Medical Gas Expansion, Building 15, Biloxi 36C25621R0054
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. 36C25621R0054 for Project 520-22-162 Medical Gas Expansion, Building 15, Biloxi
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 Name | Phone: | Fax: | |
| Email address: |
| 2. | Contract No. And Title: | ||
| Describe role (Prime/Sub) and work Performed: | |||
| Reference POC Name | Phone: | Fax: | |
| Email address: |
| 3. | Contract No. And Title: | ||
| Describe role (Prime/Sub) and work Performed: | |||
| Reference POC Name | Phone: | Fax: | |
| Email address: |
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