S02 - Attachment 06 - Subcontractor Past Performance Consent Form (2 Pages).pdf

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Attached to
Z2DA--Replace Self Closing Doors at MICU and CCU Federal contract opportunity
Solicitation number
36C24824R0088
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

About this file

This document contains a subcontractor information and consent form for a solicitation seeking construction services to replace self-closing doors at the MICU and CCU at the VA Caribbean Healthcare System in San Juan, Puerto Rico. The form requires major subcontractors to provide contact and reference information and consent to allow their past performance information to be shared with the prime contractor. Subcontractors must identify at least three references from previous government contracts where they served as either a prime contractor or subcontractor. This opportunity is set aside for Service-Disabled Veteran-Owned Small Businesses and proposals are due under Solicitation Number 36C24824R0088 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8.

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Text version

SOLICITATION ATTACHMENT

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 (if any). In an effort to assist the Government in assessing your past performance relevancy we request that this 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.

SAMPLE FORM:

__________________________ (Company name of Subcontractor or Teaming Partner) is currently planning on participating as a (Subcontractor or a Teaming Partner) with ____________________________ (prime contractor or name of entity providing proposal) for the Department of Veterans Affairs, Solicitation No. .

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 as well as our recommended references as listed on the attachment.

(Signature) / (Date) (Title of Individual with authority to sign for and legally bind the company)

Company Name: _____________________ Telephone #_________________________

Unique Entity Identifier: ____________________ Email: _________________________

Address: ____________________________________________________________

Reference List (required and not to be from proposing prime contractor):

1. Contract No. __________________________________________________

Project No. and Title: ___________________________________________

Describe your role (Prime/Sub) and work Performed __________________

Reference POC Name_______________________ Phone_______________

Email address: ________________________________

2. Contract No. __________________________________________________

Describe your role (Prime/Sub) and work Performed __________________

3. Contract No. __________________________________________________

Describe your role (Prime/Sub) and work Performed __________________

Each major subcontractor and or Teaming Partner must complete the “Subcontractor Information and Consent Form” to be considered. Offerors shall have major subcontractors identify at a minimum three (3) references, owners (if they were the Prime) or other Prime contractors they have worked for. References for subcontractors from the proposing offeror are not acceptable. Written references for subcontractors and 2nd tier subcontractors may be included and are encouraged.

File details come from the government source that posted it. Updated .