1-B-DFCM Performance References Form 2.5.25.docx
DOCX document 55 KB Posted
- Solicitation number
- CS27011
- Issued by
- Utah
About this file
This is a DFCM Past Performance References Form used by the State of Utah's Division of Facilities Construction and Management (DFCM) for the Multiple Pump House Replacements and Repairs project (Project #27329900) under the Utah Department of Transportation. The form requires contractors bidding on this project to submit up to five past performance references for projects completed within the past five years where the contractor served as the prime contractor and held the contract directly with the stakeholder. Each reference must include the project name, location, point of contact information (name, email, phone), the contact's role, project completion date, construction cost, a brief description of work performed, and key individuals involved. References must be submitted as complete and accurate information directly on the form without attachments or hyperlinks; failure to comply with these requirements results in disqualification from the selection process.
The form serves as a qualification and evaluation tool for the DFCM construction project involving repairs and replacements of five pump houses for the Utah Department of Transportation, with a construction budget of $3,242,656.00. The form includes internal DFCM fields for project number, due date and time, number of references required, and verification of references received. Contractors must provide verifiable references from direct contractual relationships to demonstrate their capability and past performance on similar construction projects before being considered for award on this solicitation.
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Text version
DFCM PAST PERFORMANCE REFERENCES
Provide references only for projects completed within the past five years where you served as the prime Contractor and held the contract directly with the stakeholder. It is the Contractors responsibility to ensure that all submitted information is complete and accurate. Failure to comply with the reference requirements will result in disqualification from the selection process. Attachments and hyperlinks are not permitted.
DFCM Project Name & Number: Click to enter text
Firm Name: Click to enter text
| Firm Contact Name: Click to enter text |
| Contact Info: Click to enter text |
REFERENCE NO. 1
| Project Name: Click to enter text |
| Point of Contact Name: (person able to answer questions about the project) |
| Click to enter text |
| Project Location (city, state): |
| Click to enter text |
| Point of Contact’s Role for the Project: |
| Click to enter text |
| Project Completion Date: |
| Click to enter text |
(month and year)
| Point of Contact Email: |
| Click to enter text |
Project Construction Cost:
| Click to enter text |
| Point of Contact Phone Number: |
Click to enter text
Brief Description of the work performed: Click to enter text
Key individuals who worked on the project: Click to enter text
REFERENCE NO. 2
| Project Name: Click to enter text |
| Point of Contact Name: (person able to answer questions about the project) |
| Click to enter text |
| Project Location (city, state): |
| Click to enter text |
| Point of Contact’s Role for the Project: |
| Click to enter text |
| Project Completion Date: |
| Click to enter text |
(month and year)
| Point of Contact Email: |
| Click to enter text |
Project Construction Cost:
| Click to enter text |
| Point of Contact Phone Number: |
Click to enter text
Brief Description of the work performed: Click to enter text
Key individuals who worked on the project: Click to enter text
REFERENCE NO. 3
| Project Name: Click to enter text |
| Point of Contact Name: (person able to answer questions about the project) |
| Click to enter text |
| Project Location (city, state): |
| Click to enter text |
| Point of Contact’s Role for the Project: |
| Click to enter text |
| Project Completion Date: |
| Click to enter text |
(month and year)
| Point of Contact Email: |
| Click to enter text |
Project Construction Cost:
| Click to enter text |
| Point of Contact Phone Number: |
Click to enter text
Brief Description of the work performed: Click to enter text
Key individuals who worked on the project: Click to enter text
REFERENCE NO. 4
| Project Name: Click to enter text |
| Point of Contact Name: (person able to answer questions about the project) |
| Click to enter text |
| Project Location (city, state): |
| Click to enter text |
| Point of Contact’s Role for the Project: |
| Click to enter text |
| Project Completion Date: |
| Click to enter text |
(month and year)
| Point of Contact Email: |
| Click to enter text |
Project Construction Cost:
| Click to enter text |
| Point of Contact Phone Number: |
Click to enter text
Brief Description of the work performed: Click to enter text
Key individuals who worked on the project: Click to enter text
REFERENCE NO. 5
| Project Name: Click to enter text |
| Point of Contact Name: (person able to answer questions about the project) |
| Click to enter text |
| Project Location (city, state): |
| Click to enter text |
| Point of Contact’s Role for the Project: |
| Click to enter text |
| Project Completion Date: |
| Click to enter text |
(month and year)
| Point of Contact Email: |
| Click to enter text |
Project Construction Cost:
| Click to enter text |
| Point of Contact Phone Number: |
Click to enter text
Brief Description of the work performed: Click to enter text
Key individuals who worked on the project: Click to enter text
--For DFCM Internal Use Only--
DFCM Project Number: Click to enter text
Due date and time: Click to enter text
Number of references needed: Click to enter text
Verified references on file with DFCM: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
DFCM Construction Performance References Form, 2.5.25 image1.jpeg
File details come from the government source that posted it. Updated .