EXHIBIT_B.doc

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Non-Clinical Case Management and Medical Records Services
Solicitation number
W912J2-19-R-0009
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Exhibit B

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Case Management Services Wisconsin Army National Guard W912J2-19-R-0009

EXHIBIT B – SUBCONTRACTOR INFORMATION AND CONSENT FORM

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 the offering contractor’s past performance relevancy and confidence, we request that the following consent form be completed by the major subcontractors/teaming partners identified in the offering contractor’s proposal. The completed consent forms should be submitted to the offering contractor for submission with subcontract past performance volume. Additionally, certain subcontractors will be required to send off questionnaires to their references. The offering contractor will inform you if this is required. Your cooperation will be appreciated.

Your Letterhead

SUBCONTRACTOR/TEAMING PARTNER CONSENT FOR THE RELEASE OF PAST PERFORMANCE INFORMATION TO THE PRIME CONTRACTOR AND REFERENCE INFORMATION

__________________ (Name of Firm) is currently participating as a (subcontractor/teaming partner) with (prime contractor or name of entity providing proposal) in responding to W912J2-19-R-0009. 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)

Company Name: ________________________

Address:

City/State/Zip Code:______________________ Date:_____________________

Reference List (required): Reference cannot be from the contractor proposing on this solicitation.

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: _________________________________________________________________

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