26-014R WRWWTF Electrical Building Design-Build Entity Reference Form.docx
DOCX document 86 KB Posted
- Solicitation number
- RFP 720 WUD 26-014R 1
- Issued by
- Palm Beach County, Florida
About this file
This is a Design-Build Entity Reference Form for the Western Region Wastewater Treatment Facility Phase 2 Electrical Building & Resiliency Improvements Progressive Design-Build project, identified as Project No. 26-014R, Package GL04, administered by Palm Beach County Utilities Department (PBCWUD) in Palm Beach County, Florida. The form requires design-build entities to submit proposer information including company name, business address, contact details, and authorized representative credentials. Proposers must provide a minimum of three project references as specified in the Design-Build Entity Minimum Qualifications document, with each reference requiring the reference contact name and title, telephone number, email address, contract year and amount, project title, project location, and a detailed description of the project.
The reference form serves as a qualification submission document for the progressive design-build procurement process and must be completed in the prescribed format. This document does not specify pricing terms, contract duration, award dates, or funding sources, as it functions solely as a reference verification instrument to evaluate the qualifications and experience of proposing entities based on their demonstrated past performance on similar projects.
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Text version
DESIGN-BUILD ENTITY REFERENCE FORM
WESTERN REGION WASTEWATER TREATMENT FACILITY PHASE 2 ELECTRICAL BUILDING & RESILIENCY IMPROVEMENTS PROGRESSIVE DESIGN-BUILD
PBCWUD PROJECT NO. 26-014R, PACKAGE IDENTIFICATION NO. GL04
PALM BEACH COUNTY, FLORIDA
THE REFERENCE FORM SHALL BE SUBMITTED IN THE FORMAT ATTACHED.
THE DESIGN-BUILD ENTITY MUST COMPLETE THE FOLLOWING INFORMATION AND ANY OTHER INFORMATION OR ATTACHMENTS.
PROPOSER’S INFORMATION
COMPANY NAME:
BUSINESS ADDRESS:
CITY, STATE, ZIP CODE:
TELEPHONE:
FAX:
E-MAIL:
PRINT NAME OF AUTHORIZED REPRESENTATIVE:
TITLE OF AUTHORIZED REPRESENTATIVE:
SIGNATURE OF AUTHORIZED REPRESENTATIVE:
REFERENCE NO. 1 (1)
Reference Name/Title/Corporation Name:
Reference Telephone Number:
Reference E-Mail Address:
Contract Year/Amount:
Project Title:
Project Location:
Description of Project:
(1) Add references as required by the Design-Build Entity Minimum Qualifications document.
REFERENCE NO. 2 (1)
Reference Name/Title/Corporation Name:
Reference Telephone Number:
Reference E-Mail Address:
Contract Year/Amount:
Project Title:
Project Location:
Description of Project:
REFERENCE NO. 3 (1)
Reference Name/Title/Corporation Name:
Reference Telephone Number:
Reference E-Mail Address:
Contract Year/Amount:
Project Title:
Project Location:
Description of Project:
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