3-Authorization for Release of Performance Information Waiver.pdf
PDF 1 MB Posted
- Solicitation number
- RFQ-26-180 Professional Design Services for 40th Street: Avenue 6E to 7E
- Issued by
- Yuma County, Arizona
About this file
This is an Authorization for Release of Performance Information and Waiver form for the City of Yuma, Arizona, related to RFQ-26-180 for Professional Design Services for 40th Street: Avenue 6E to Avenue 7E. The form requires a company representative to authorize the disclosure of performance information and construction history to the City of Yuma and its representatives. The authorization permits any companies and government entities listed in the company's Statement of Qualifications, as well as any other government entity for which the company has performed construction services, to release records, information, and opinions concerning the company's construction performance to the City of Yuma for reference purposes. The completed and signed authorization must be submitted with the company's Statement of Qualifications and remains effective for the term of the contract.
By executing this waiver, the company relinquishes any claims it may have against the City of Yuma or any third-party entity providing performance information or opinions regarding the company's actions or performance. The authorization is valid in original form or as a photostat copy, and the document includes designated spaces for the date, signature, printed name, title, company name, and RFQ number. This document serves as a standard requirement in the procurement process to facilitate the City's due diligence in evaluating contractor qualifications and past performance history.
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Text version
AUTHORIZATION FOR RELEASE OF
PERFORMANCE INFORMATION AND WAIVER
I, ______________________________________, the undersigned, on behalf of ___________________________________________ (this company), do hereby consent and authorize all those companies and government entities listed in my
Statement of Qualifications and any other government entity for whom this company has performed construction services, to disclose and release to the City of Yuma, or their representatives, information, records and opinions concerning this company’s construction performance. The purpose of this disclosure is to provide references to the City of Yuma. ________________________________ hereby waives any claim it may have against the City of Yuma or any company or entity providing information to the City of Yuma by reason of any information being disclosed or opinions provided regarding the actions or performance of this company.
This authorization for disclosure of information is effective for the term of the contract.
This consent or Photostat copy of this authorization shall be as valid and effective as the original.
Dated:
Signature:
Printed Name:
Title:
Return this completed and signed document with your Statement of Qualifications
RFQ #
Project:
| RFQ#: RFQ-26-180 |
| Project Name: Professional Services for 40th Street: Avenue 6E to 7E |
| Company Name: |
| Name: |
| Title: |
| Date9_af_date: |
File details come from the government source that posted it. Updated .