25-84131500-ITN DFS BOR Attachment P Reference Form.pdf
PDF 156 KB Posted
- Attached to
- Insurance Broker of Record - Reinsurance Broker for Property and Casualty lines, Risk Management and
- Solicitation number
- ITN-13124
- Issued by
- St. Johns County, Florida
About this file
The document is an Invitation to Negotiate (ITN) Reference Form for the Department (presumably the Florida Department of Financial Services), specifically Attachment P of ITN No. 25-84131500-ITN. This reference form provides instructions and a template for potential respondents to submit three separate, verifiable client references for work similar to the services being solicited. The form outlines strict requirements for references, including that they cannot be subcontractors, affiliated entities, or confidential references, and must be available during normal business hours for potential contact by the Department.
The Department will attempt to contact each reference up to four times to complete an Evaluation Questionnaire for Past Performance. If references cannot be reached or are unwilling to provide information, this will be noted in the evaluation. The Department also reserves the right to contact additional references not initially identified by the respondent to assess the vendor's past performance and determine if they are a "responsible vendor" as defined in Florida Statutes. Each reference form requires detailed information including contact persons, phone numbers, contract performance period, location of services, and a brief description of services performed.
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Text version
ITN No.: 25-84131500-ITN
ITN No.: 25-84131500-ITN
Attachment P
Reference Form
On the following pages, the Respondent will provide, if requested during negotiations, the information indicated for three (3) separate and verifiable client references. The references listed must be for work similar in nature to that specified in this solicitation.
The same reference may not be listed for more than one (1) organization and confidential references shall not be included. In the event the Respondent has had a name change since the time work was performed for a listed reference, the name under which the Respondent operated at that time must be provided in the space provided for Respondent’s Name.
References that are listed as subcontractors in the response will not be accepted as references under this solicitation. Entities having an affiliation with the Respondent (i.e.
currently parent, subsidiary having common ownership, having common directors, officers or agents or sharing profits or liabilities) may not be accepted as references under this solicitation.
The Department will attempt to contact the three (3) references provided by the Respondent. The total number of references contacted to complete an Evaluation Questionnaire for Past Performance for any response will be three (3).
References should be available for contact during normal business hours, 9:00 AM – 5:00 PM, Eastern Time. The Department will attempt to contact each reference by telephone up to four (4) times. In the event the contact person indicated cannot be reached following four (4) attempts or is unwilling to provide the requested information, the Department will note these events for that reference evaluation. The Department will not correct incorrectly supplied information.
Additionally, the Department reserves the right to contact references other than those identified by the Respondent to obtain additional information regarding past performance. Any information obtained as a result of such contact may be used to determine whether or not the Respondent is a “responsible vendor”, as defined in section 287.012(24), Florida Statutes.
Reference # 1
Respondent’s Name:
Reference’s Name:
Address:
Primary Contact Person: Alternate Contact Person:
Primary Phone Number: Alternate Phone Number:
Primary Fax Number: Alternate Fax Number:
Contract Performance Period:
Location of Services:
Brief description of the services performed for this reference:
Reference # 2
Address:
Primary Contact Person: Alternate Contact Person:
Primary Phone Number: Alternate Phone Number:
Primary Fax Number: Alternate Fax Number:
Contract Performance Period:
Reference # 3
Address:
Primary Contact Person: Alternate Contact Person:
Primary Phone Number: Alternate Phone Number:
Primary Fax Number: Alternate Fax Number:
Contract Performance Period:
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