11-Vendor Reference Verification - PNC2131343P1.docx

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Attached to
North Perry Airport (HWO) - Lead Emmission Screening
Solicitation number
PNC2131343P1
Issued by
Broward County, Florida

About this file

This is a Vendor Reference Verification Form template issued by Broward County, Florida for solicitation PNC2131343 P1 concerning lead emissions screening services at North Perry Airport (HWO). The form is designed to collect reference information from vendors responding to the County's Request for Proposal. Vendors must provide a minimum of three references from organizations other than the Broward County Board of County Commissioners, completed on the provided template. If references are not submitted with the initial proposal or cannot be verified, vendors have three business days following the County's written request to submit the completed verification forms. The form requests vendors to identify a reference organization, provide contact information for the reference, document the referenced project details including contract number and service dates, specify the vendor's role as either prime contractor or subconsultant/subcontractor, and confirm the project amount.

The reference verification form requires the reference organization to rate the vendor's performance across multiple categories including quality of service (responsiveness, accuracy, deliverables), organizational attributes (staff expertise, professionalism, turnover), timeliness of project and deliverable completion, budget adherence, and cooperation with the vendor's firm, subcontractors/subconsultants, and regulatory agencies. Ratings are provided on a scale of "Needs Improvement," "Satisfactory," "Excellent," or "Not Applicable," and the reference must indicate whether they would use the vendor again. The County verifies all information submitted and reserves the right to reject proposals, rescind awards, terminate contracts, or initiate debarment proceedings based on inaccurate, untruthful, or incorrect statements in the vendor's response.

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Text version

VENDOR REFERENCE VERIFICATION

REQUEST FOR PROPOSAL, REQUEST FOR QUALIFICATION, OR REQUEST FOR LETTER OF INTEREST

Vendor should provide a minimum of three (3) non-Broward County Board of County Commissioners’ references or as per Evaluation Criteria instructions. Vendor should provide the Vendor Reference Verification Form to its reference organization/firm to complete and return to the Vendor’s attention.

Completed Vendor Reference Verification Forms should be submitted with submittal. If not provided with submittal, or if reference is not able to be verified, the Vendor must submit form(s) (or a new Vendor Reference Verification Form) within three business days after the County's written request.

VENDOR REFERENCE VERIFICATION FORM (RFP/RLI/RFQ)

Solicitation No. & Title: PNC2131343 P1 North Perry Airport (HWO) Lead Emission Screening

Reference For (hereinafter, “Vendor”):
Click or tap here to enter text.
Reference Date:
Click or tap here to enter text.
Organization/Firm Providing Reference:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Contact Title:
Click or tap here to enter text.
Contact Email:
Click or tap here to enter text.
Contact Phone:
Click or tap here to enter text.
Name of Referenced Project:
Click or tap here to enter text.
Contract Number:
Click or tap here to enter text.
Date Range of Services Provided:
Start Date:
End Date:
Project Amount:
Click or tap here to enter text.
Vendor’s Role in Project:
☐ Prime
☐ Subconsultant/Subcontractor
Would you use this Vendor again?
☐ Yes
☐ No

If you answered no to the question above, please specify below: (attach additional sheet if needed) Click or tap here to enter text.

Description of services provided by Vendor, please specify below: (attach additional sheet if needed) Click or tap here to enter text.

Please rate your experience with the referenced Vendor via checkbox:
Needs Improvement
Satisfactory
Excellent
Not Applicable

Vendor’s Quality of Service:

Responsive:
☐☐☐☐
Accuracy:
☐☐☐☐
Deliverables:
☐☐☐☐
Vendor’s Organization:
Staff Expertise:
☐☐☐☐
Professionalism:
☐☐☐☐
Turnover:
☐☐☐☐
Timeliness of:
Project:
☐☐☐☐
Deliverables:
☐☐☐☐
Project completed within budget:
☐☐☐☐
Cooperation with:
Your Firm:
☐☐☐☐
Subcontractor(s)/Subconsultant(s):
☐☐☐☐
Regulatory Agency(ies):
☐☐☐☐
All information provided to Broward County is subject to verification. Vendor acknowledges that inaccurate, untruthful, or incorrect statements made in support of this response may be used by the County as a basis for rejection, rescission of the award, or termination of the contract and may also serve as the basis for debarment of Vendor pursuant to the Broward County Procurement Code.

***THE SECTION BELOW IS FOR COUNTY USE ONLY***

Verified via:
☐ Email
Verified by:
Click or tap here to enter text.Division:
Click or tap here to enter text.

☐ Verbal

Date:
Click or tap here to enter text.

Vendor Reference Verification Form – RFP/RLI/RFQ Form Date 4/1/25 image1.png

File details come from the government source that posted it. Updated .