1-C-DFCM Performance References Form 2.5.25 (1).docx
DOCX document 55 KB Posted
- Solicitation number
- CS27009-Stage 1
- Issued by
- Weber County, Utah
About this file
This is a Past Performance References Form issued by the State of Utah Division of Facilities Construction and Management (DFCM) for use in evaluating contractor qualifications on construction projects. The form requires bidders to provide up to five references for projects completed within the past five years where the firm served as the prime contractor with direct contracts to stakeholders. Each reference must include detailed project information including the project name and number, point of contact name and contact details, project location, completion date, construction cost, description of work performed, and key personnel involved. The instructions emphasize that attachments and hyperlinks are not permitted and that failure to comply with the reference requirements will result in disqualification from the selection process. The form is designed to verify a contractor's past performance and experience before contract award.
The form relates to DFCM Construction VBS Construction Stage I for the Northern Utah Veterans Cemetery (Project #26360490), a new veterans memorial cemetery construction project in Washington Terrace, Utah with an estimated construction cost of $12,000,000.00. The scope of work includes site improvements, utility infrastructure, hardscape, irrigation and landscaping installation, and building construction. Contractors must ensure all submitted information is complete and accurate, with verification of references conducted by DFCM for internal tracking purposes. The form contains designated fields for DFCM internal use only, including project number, due date and time, and number of references needed, as well as checkboxes to track which verified references are on file.
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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
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