1-C-DFCM Performance References Form 2.5.25 (1).docx
DOCX document 55 KB Posted
- Solicitation number
- MP27006-Stage 1
- Issued by
- Utah
About this file
This is a DFCM Past Performance References Form used by the State of Utah Division of Facilities Construction and Management (DFCM) for contractor evaluation on the USCF Water Pump Station Modification & Fire Storage Tank project (#26032100). The form requires prospective contractors to submit up to five past performance references for projects completed within the past five years where the contractor served as the prime contractor. Each reference must include comprehensive project details: project name, point of contact information (name, email, phone, and role), project location, completion date, construction cost, brief description of work performed, and key individuals involved. The form explicitly states that contractors must ensure all submitted information is complete and accurate, with failure to comply with reference requirements resulting in disqualification from the selection process. Attachments and hyperlinks are not permitted in the submission.
The USCF Water Pump Station Modification & Fire Storage Tank project carries a construction cost estimate of $2,500,000.00 and involves adding a dedicated fire water storage tank and new valve building to separate the culinary water and fire water systems on the USCF campus in Utah. The form contains internal DFCM sections for project number assignment, due date tracking, and verification documentation of submitted references. No set-asides, incumbent information, or specific funding sources are indicated in this reference form, which functions primarily as an evaluation tool to assess contractor qualifications and past performance capability for this state construction project.
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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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