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This document contains an exhibit form for a surety bond and information on a related federal contract opportunity for replacing refrigerators and freezers at a Veterans Affairs medical center. The contract opportunity is a 100% set-aside for service-disabled veteran-owned small businesses, with a solicitation number of 36C25621R0127 and NAICS code 236220. Proposals are due around July 7, 2021 for the project, with an anticipated 180-day performance period after notice to proceed. The construction cost range is between $500,000 and $1 million. Offerors must be verified as SDVOSBs in the Vendor Information Pages database and registered in SAM.gov by the time of proposal submission. The surety form requires information on bonding limits, claims history, and time insuring the contractor for the medical center project located in Shreveport, Louisiana.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 667-21-101, Replace NFS and Pharmacy Refrigerators and Freezers 36C25621R0022

EXHIBIT E

SURETY FORM

OFFEROR INSTRUCTIONS: To be completed by Surety and SUBMITTED BY OFFEROR AS A PART OF THE TECHNICAL PROPOSAL PACKAGE.

Contractor Name:

Address:

Telephone: Email:

Please complete below and return no later than:

Surety Name:

Surety Address:

POC:Title:
Telephone:Email:

How long have you provided bonding for the above contractor? YEARS What is the contractor’s rating?

Bonding Limit for a single project?$
Aggregate amount?$

Have you ever had to complete a project for the contractor? [ ] YES [ ] NO Has liability insurance ever been refused? [ ] YES [ ] NO Have there been complaints of non-payment by subcontractor/suppliers? [ ] YES [ ] NO Has the surety had to pay subcontractors/suppliers? [ ] YES [ ] NO

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