W911SA22B2003 Appendix A Surety Acknowledgement of Coefficient.docx

W911SA22B2003 Hoosier JOC

Surety Acknowledgement of Coefficient To be completed if offered coefficient is less than 1.00 See Statement of Work Coefficient/Wage Determination

OFFEROR INSTRUCTIONS: Section A (if required) shall be completed by the bidder and submitted to their Surety requesting they complete and return to the bidder, and is included in the bid package. Note: failure to submit at time of bid will result in the bid being non-responsive.

Section A Prospective Contractor information:

Contractor Name:

Address:

Point of Contact:

Telephone:

E-mail:

Coefficient Bid: Average Pre-Priced: Average Non-Pre-Priced:

SURETY INSTRUCTIONS: SECTION B shall be completed by the Surety and returned to the bidder such that it is included with their IFB bid package. The Government expects reasonable coefficient(s) to accomplish the resulting task orders. Submitted coefficient(s) less than one (1.00) will require an acknowledgement from the bonding company that work will be bid and may be potentially accomplished at less than cost.

Surety Acknowledgement of coefficient less than 1.00:

Section B

Surety Name:

Surety Address:

Telephone:

E-mail:

Name/Title:

Signature:

Appendix A – Surety Acknowledgement of Coefficient