EXHIBIT C SUBCONTRACTOR INFORMATION AND CONSENT.docx

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Z1DA--Project #502-19-102 Replace Roof and HVAC System for Building 3
Solicitation number
36C25621R0112
Issued by

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This exhibit form requests consent from major subcontractors and teaming partners for the release of past performance information to the prime contractor for project 502-19-102 to replace the roof and HVAC system at Building 3. Subcontractors are asked to provide contact information, describe relevant past work experience and performance on three federal contracts as references, and sign to allow their past performance to be discussed with prospective prime contractors during the source selection process. The related federal contract opportunity posting is to notify potential Service-Disabled Veteran-Owned Small Businesses of the requirement to replace the roof and HVAC at the Alexandria VA Health Care System for between $5 million and $10 million. The solicitation will be issued on June 15 on beta.SAM.gov as a 100% set-aside for SDVOSBs under FAR procedures. The prime contractor must perform at least 15% of on-site work with own employees or other SDVOSBs for general construction or 25% for special trade work.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 502-19-102 Replace BLDG 3 Roof & HVAC 36C25621R0112

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. 36C25621R0112 for Project 502-19-102 Replace BLDG 3 Roof and HVAC

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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