3-Past Present.pdf

PDF 137 KB Posted

Attached to
Insurance Brokers of Record - Qualified Suppliers List
Solicitation number
RFP-RC-2026-015
Issued by
Rockland County, New York

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This is a Past and Present Performance Information Form for the Insurance Brokers of Record - Qualified Suppliers List procurement issued by Rockland County, New York under RFP-RC-2026-015. The form requires offerors to submit detailed information about relevant past contract performance, including the contracting entity name, contract title, contract term, original and current contract values, and a brief description of the work performed with identification of whether the offeror served as a prime or subcontractor. Offerors must provide original and final contract dates, the number of any change orders issued, and the primary causes or reasons for those changes. The form also requires offerors to identify whether subcontractors were used and specify their names and percentage of contract responsibility.

The form mandates that offerors provide current contact information for both the primary customer point of contact (reference program/project manager) and reference contracting officer, including names, addresses, telephone numbers, fax numbers, and email addresses. Offerors must also identify by name any key individuals who participated in the referenced contract and are proposed to support the insurance broker procurement. This performance information is required to be included as part of the technical proposal submission, with limitations on the number of past efforts and length of each submission as specified in the procurement specifications.

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6-RFP-RC-2026-015 - Insurance Brokers - QSL.pdf PDF
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Edwin J. Day, County Executive

PAST & PRESENT PERFORMANCE INFORMATION FORM

COMPLETE AND INCLUDE THIS FORM IN YOUR TECHNICAL PROPOSAL

NAME OF OFFEROR: __________________________________

Provide the information requested on this form for each contract/program being described as a reference. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Limit the number of past efforts submitted and the length of each submission to the limitations, if any, set forth in specifications.

Name of Contracting Entity: ___________________________________ Contract Name/Title: __________________________________

Term of Contract: ____________________________

Original Contract Value: ________________________________ Current or Final Contract Value: _______________________________________

A. Brief Description of your effort. Identify whether you were a Prime or Subcontractor.

1. Original Date: ______________________________ 2. Current or Final Date: __________________________

3. Number of Change Orders (if any): ________________

Primary Causes or Reasons of Change: ________________________________________________________________________

B. Primary Customer Points of Contact:

NOTE: CONFIRM CONTACT INFORMATION PROVIDED IS CURRENT PRIOR TO SUBMISSION.

Reference Program/Project Manager:

Name:______________________________________________________

Address:____________________________________________________

Telephone: ______________________ Fax: _______________________

E-mail: _____________________________________________________

Reference Contracting Officer

Name:__________________________________________________

Address: _______________________________________________

Telephone: ___________________ Fax: ___________________

E-mail: _________________________________________________

C. If subcontractors were used, identify the names of the subcontractors and the percentage of the contract the subcontractor was responsible for. ____________________________________________________________________________________________

D. Specify, by name, any key individual(s) who participated in this contract and are proposed to support acquisition detailed in the RFP.

Insurance Brokers of Record - Qualified Suppliers List RFP-RC-2026-015

MoodieC Highlight

NAME OF OFFEROR:
Name of Contracting Entity:
Contract Name/Title:
Term of Contract:
Original Contract Value:
Current or Final Contract Value:
A:
1 Original Date:
3 Number of Change Orders (if any):
Primary Causes or Reasons of Change:
Primary Causes or Reasons of Change_1:
2 Current or Final Date:
2 Current or Final Date_1:
responsible for:
D:
D_1:
Name:
Address:
Telephone:
Fax:
E-mail:
Name_1:
Address_1:
Telephone_1:
Fax_1:
E-mail_1:

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