25-84131500-ITN DFS BOR Attachment P Reference Form.pdf
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- 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
Attachment P Reference Form for Invitation to Negotiate (ITN) No. 25-84131500-ITN is issued by the Florida Department of Management Services on behalf of the Department of Financial Services' Division of Risk Management. The document provides a template for respondents to list three separate, verifiable client references for work similar in nature to the solicitation. References must be available during normal business hours (9:00 AM - 5:00 PM Eastern Time), and the Department will attempt to contact each reference up to four times. The references cannot be subcontractors, affiliated entities, or confidential sources, and the same reference cannot be listed for more than one organization.
The reference form requires detailed information for each reference, including the respondent's name, reference's name, address, contact persons, phone and fax numbers, contract performance period, location of services, and a brief description of services performed. The Department reserves the right to contact references beyond those initially provided to evaluate the respondent's past performance and determine if they qualify as a "responsible vendor" under Florida Statutes. This process is part of a comprehensive evaluation to select a Broker of Record and Reinsurance Broker for property and casualty insurance services for state agencies and universities.
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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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