S02 Sol R0036 AttF SOW.Att19_Subcontractor Info Consent 578-25-003.pdf
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- Attached to
- Z1DA--578-25-003 Renovate Elevators B200 (Construction) at the Hines VA Hospital in Hines, IL
- Solicitation number
- 36C25225R0036_3
About this file
This document is a Subcontractor or Teaming Partner Information and Consent Form for a Department of Veterans Affairs solicitation to renovate elevators in Building 200 at the Hines VA Hospital. The form is designed to obtain consent from major subcontractors (including Elevator Manufacturer, Elevator Installer, Electrical, Telecom, Security, and Fire Protection) to allow the prime contractor to discuss their past and present performance information during the source selection process.
The form provides a template for subcontractors to list up to four reference projects, including contract numbers, project titles and locations, the subcontractor's role and work performed, and contact information for reference points of contact. By signing the form, subcontractors acknowledge the government's emphasis on past performance and agree to allow performance information to be shared with the prime contractor for evaluation purposes. The solicitation number is 36C25225R0036 and the project number is 578-25-003, focused on elevator renovations at the Hines VA Hospital in Illinois.
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Text version
SOURCE SELECTION SENSITIVE
FAR 2.101 & 3.104-5
Solicitation 36C25225R0036
Project 578-25-003 Renovate Elevators in Bldg 200
Attachment F – Subcontractor Info Consent Page 1 of 4
Solicitation Attachment F
Subcontractor or Teaming Partner Information and Consent Form
Subcontractor 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 this consent form be completed by the major subcontractors/teaming partners identified in your proposal.
Major subcontractors include:
1.) Elevator Manufacturer
2.) Elevator Installer
3.) Electrical
4.) Telecom
5.) Security
6.) Fire Protection
Attachment F – Subcontractor Info Consent Page 2 of 4
SAMPLE FORM from SUBCONTRACTOR or TEAMING PARTNER:
__________________________(company name) is currently planning on participating as a
(Subcontractor or Teaming Partner) with ___________________________________________
(prime contractor or name of entity providing proposal) for the Department of Veterans Affairs
RFP 6C25225R0036 for Project 578-25-003 Renovate Elevators in Bldg 200.
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.
Name Title of individual with authority to sign for, and legally bind the company
Email Phone
Address of Record
** See listed attachments on following page(s) **
Attachment F – Subcontractor Info Consent Page 3 of 4
Reference List (company OTHER THAN with prime contractor associated with this solicitation):
1. Contract # __________________________________________________________
Project # and Title: __________________________________________________________
Project Location: __________________________________________________________
Describe your role (Prime/Sub) work performed and value: __________________________
Reference POC Name______________________________ Phone_____________________
Email address: ______________________________________________________________
2. Contract # __________________________________________________________
Project Location: __________________________________________________________
Describe your role (Prime/Sub) work performed and value: __________________________
Attachment F – Subcontractor Info Consent Page 4 of 4
3. Contract # __________________________________________________________
Project Location: __________________________________________________________
Describe your role (Prime/Sub) work performed and value: __________________________
4. Contract # __________________________________________________________
Project Location: __________________________________________________________
Describe your role (Prime/Sub) work performed and value: __________________________
File details come from the government source that posted it. Updated .