12-Vendor Reference Verification, GEN2129113P1, Group Long Term Disability Insurance.docx
DOCX document 47 KB Posted
- Attached to
- Group Long Term Disability Insurance
- Solicitation number
- GEN2129113P1
- Issued by
- Broward County, Florida
About this file
This document is a Vendor Reference Verification Request for Proposal (RFP) issued by Broward County's Human Resources Division for Group Long Term Disability Insurance. The solicitation (GEN2129113P1) seeks a qualified firm to provide insurance enrollment support and administration services for benefit-eligible employees, with vendors required to submit a minimum of three non-Broward County references. Vendors must complete a detailed reference verification form that captures project details, service ratings, and performance evaluations, and must submit their responses electronically through the BPRO (Broward Procurement) system by a specified closing date.
The solicitation includes specific requirements such as an ETS Vendor Security Questionnaire and procurement preferences for Small Business Enterprises and County Business Enterprises. Vendors are instructed to submit questions through BPRO by a designated question due date, with the County responding in the system's Messages section. The reference verification form allows references to rate the vendor's performance across multiple dimensions including service quality, responsiveness, accuracy, staff expertise, professionalism, and project timeliness. Vendors are cautioned that inaccurate statements may result in proposal rejection, award rescission, contract termination, or potential debarment under the Broward County Procurement Code.
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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: GEN2129113P1 Group Long Term Disability Insurance
| 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 the project amount $. |
| 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: | |
| 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 – RFP/RLI/RFQ Form Date 4/1/25 image1.png
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