4-RCO-RC-2025-010 Certificate of Experience.pdf

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Attached to
Compact Automated Titration System, Installation and Training
Solicitation number
RCO-RC-2025-010
Issued by
Rockland County, New York

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This document is a Certificate of Experience form from the County of Rockland's Department of General Services (DGS) Purchasing Division, located at 50 Sanatorium Rd, Pomona, NY 10970, for a solicitation identified as RCO-RC-2025-010 for a Compact Automated Titration System, including installation and training. The form is designed for vendors to document their prior work experience within the last three years, requiring bidders to complete and submit this certificate with their bid proposal.

The form provides space for vendors to list up to five previous business references, including details such as business name, contact information, contract amount, type of work performed, and contact details. At the bottom of the form, there are signature lines for the bidder to complete, certifying the accuracy of the information provided. The purpose of this certificate appears to be to allow the County of Rockland to evaluate the vendor's qualifications, past performance, and experience relevant to the current procurement for the automated titration system.

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Other files

File Type Posted
1-Appendix A General Terms and Conditions - Commodities and Non-Professional Services.pdf PDF
3-RCO-RC-2025-010- Automated Compact Titration System.pdf PDF
2-RCO-RC-2025-010 Statement of Disclosures.pdf PDF

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PAGE: 1

COUNTY OF ROCKLAND - DGS-PURCHASING

BLDG. A., 6th FLOOR, 50 SANATORIUM RD, POMONA, NY 10970

TELEPHONE: 845-364-3820 / TELEFAX: 845-364-3809

CERTIFICATE OF EXPERIENCE

(THIS FORM MUST BE COMPLETED BY VENDOR AND SUBMITTED WITH BID)

I _____________________________________________ HEREBY CERTIFY THAT (COMPANY) ____________________________

_____________________________________ HAS PERFORMED THE FOLLOWING WORK WITHIN THE LAST THREE YEARS:

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BIDDER: _____________________________________________ BY: ___________________________________________________

TITLE: ________________________________________________________ SIGNATURE_____________________________________________

RCO-RC-2025-010 Compact Automated Titration System, Installation and Training

NAME OF BIDDER: _____________________________________________ BY: ___________________________________________________

I:
HEREBY CERTIFY THAT COMPANY:
HAS PERFORMED THE FOLLOWING WORK WITHIN THE LAST THREE YEARS:
NAME OF BUSINESS:
CONTACT NAME:
ADDRESS:
AMOUNT OF CONTRACT:
TELEPHONE NO:
TYPE OF WORK:
EMAIL ADDRESS:
FAX NO:
NAME OF BUSINESS1:
CONTACT NAME1:
ADDRESS1:
AMOUNT OF CONTRACT1:
TELEPHONE NO1:
TYPE OF WORK1:
EMAIL ADDRESS1:
FAX NO1:
NAME OF BUSINESS2:
CONTACT NAME2:
ADDRESS2:
AMOUNT OF CONTRACT2:
TELEPHONE NO2:
TYPE OF WORK2:
EMAIL ADDRESS2:
FAX NO2:
NAME OF BUSINESS3:
CONTACT NAME3:
ADDRESS3:
AMOUNT OF CONTRACT3:
TELEPHONE NO3:
TYPE OF WORK3:
EMAIL ADDRESS3:
FAX NO3:
NAME OF BUSINESS4:
CONTACT NAME4:
ADDRESS4:
AMOUNT OF CONTRACT4:
TELEPHONE NO4:
TYPE OF WORK4:
EMAIL ADDRESS4:
FAX NO4:
NAME OF BIDDER:
BY:
TITLE:
Text Field0:

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