EXHIBIT C SUBCONTRACTOR INFORMATION AND CONSENT.docx

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Z1DZ--667-21-4-513-0184 - Project 667-21-101 Replace NFS and Pharmacy Refrigerators and Freezers (VA-21-00058352)
Solicitation number
36C25621R0127
Issued by

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This document includes an exhibit for subcontractor consent and reference information related to a solicitation for replacing refrigerators and freezers at a Veterans Affairs medical center. The solicitation will be issued as a 100% set-aside for service-disabled veteran-owned small businesses to replace refrigerators and freezers at the Overton Brooks VA Medical Center in Shreveport, Louisiana under project number 667-21-101. The request for proposals is expected to be issued on or around June 7, 2021 with proposals due approximately July 7, 2021. The contract award date will be approximately 30 days after receipt of proposals. The contract performance period is 180 calendar days from the notice to proceed. The construction cost range for the project is between $500,000 to $1,000,000. Interested offerors must be registered and verified as a service-disabled veteran-owned small business in the Vendor Information Pages database.

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Text version

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 36C25621R0127 Replace NFS and Pharmacy Refrigerators and Freezers

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. 36C25621R0127 for Project 667-21-101, Replace NFS and Pharmacy Refrigerators and Freezers

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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