S02-657A4-21-800-ATTACHMENT 3-Surety Form.pdf
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- Attached to
- Z2DA--657A4-21-800, TF - FCA - Remove and Replace End-of-Life HVAC Infrastructure Building 1
- Solicitation number
- 36C25525R0009
About this file
This is a Surety Form template (Attachment 3) for solicitation 36C25525R0009, which is part of a VA contract for removing and replacing end-of-life HVAC infrastructure in Building 1. The form must be completed in two parts - first by the offeror and then by their surety company - and submitted by January 16, 2025.
The form requires the surety company to provide information about their relationship with the contractor, including length of bonding history, contractor's rating, single project bonding limit, aggregate amount, and risk factors such as whether they've had to complete projects for the contractor, if liability insurance has been refused, or if there have been payment issues with subcontractors/suppliers. Completed forms must be submitted to the Department of Veterans Affairs Network Contracting Office 15 in Leavenworth, KS, either by mail or email to the specified contract specialist.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104
657A4-21-800 TF - FCA - Remove and Replace End-of-Life Heating, Ventilation and Air Conditioning Infrastructure Building 1
36C25525R0009
ATTACHMENT 3
SURETY FORM
OFFEROR INSTRUCTIONS: To be completed by Offeror and submitted to Surety requesting they complete and return as indicated on Surety Instructions, by no later than January 16, 2025
Contractor Name: ______________________________________________________ Address: _________________________________________________ Telephone: ___________________________________________ Please complete below and return as per instructions no later than: January 16, 2025.
SURETY INSTRUCTIONS: To be completed by Surety and returned no later than January 16, 2025 with proposal to:
Department of Veterans Affairs Network Contracting Office 15 Attn: Gislaine Dorvil, Contract Specialist Regular Mail: 3450 S 4th Street Trafficway
Leavenworth KS 66048 or via e-mail to Lucia.Cowsert@va.gov
FedEx: 3450 S 4th Street Trafficway Leavenworth KS 66048
Surety Name:__________________________________________________ Surety Address: ___________________________________________
Telephone: _________________________ Facsimile: _____________________ 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 mailto:Gislaine.Dorvil@va.gov
| Attachment 3 |
| SURETY FORM |
File details come from the government source that posted it. Updated .