EXHIBIT C SUBCONTRACTOR INFORMATION AND CONSENT.docx

DOCX document 44 KB Posted

Attached to
Z1DA--Installation of Additional Environmental Monitors Federal contract opportunity
Solicitation number
36C25621R0131
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

About this file

This document contains a subcontractor consent form and information related to a federal solicitation for installation of additional environmental monitors. The solicitation is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 for project number 629-21-102. Interested offerors must be verified as a Service-Disabled Veteran-Owned Small Business and registered in the System for Award Management database. The construction cost range is between $500,000 and $1 million and the applicable North American Industry Classification System code is 238220. The prime contractor must perform at least 15% of on-site work with own employees or other SDVOSBs for general construction, or 25% for construction by specialty trade contractors. The solicitation will be posted on beta.SAM.gov on June 4, 2021 and questions are due by an unspecified cutoff date.

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Text version

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 629-21-102 Installation of Additional Environmental Controls 36C25621R0131

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. 36C25621R0131 for Project 629-21-102 Installation of Additional Environmental Controls

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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