SOW Attachment 12 - Subcontractor Information and Consent Form.pdf

EXHIBIT B – SUBCONTRACTOR INFORMATION AND CONSENT FORM

Each major subcontractor and/or Teaming Partner identified in your technical proposal must complete an Exhibit B, “Subcontractor Information and Consent Form” to be considered. Written references for subcontractors may be included and are encouraged; however, subcontractors do not need to send out past performance questionnaires. Multiple Subcontractors may be named for the same discipline, but you are limited to a maximum of three (3) subcontractors per discipline.

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 shall be submitted to the offering contractor for submission with the technical proposal.

(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 Number 36C24123R0150 – 402-23-102 - Medical Gas System Upgrade issued by the Department of Veterans Affairs - VA Medical Center, 1 VA Center, Augusta, Maine, 04330.

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

Address:

City/State/Zip Code: Date:

Reference List (required):

1. Contract No. And Title

Describe your role (Prime/Sub) and work Performed

Reference POC Name Phone Fax

Email address:

2. Contract No. And Title

Describe your role (Prime/Sub) and work Performed

Reference POC Name Phone Fax

Email address:

3. Contract No. And Title

Describe your role (Prime/Sub) and work Performed

Reference POC Name_ Phone Fax

Email address: