ATTACHMENT 17- KEY STAFF REFERENCE FORM.pdf

ATTACHMENT 17: KEY STAFF REFERENCE FORM

ATTACHMENT 17: KEY STAFF REFERENCE FORM

Bidder Instructions: Complete Part A, items 1–8 of this attachment, ATTACHMENT 17: KEY STAFF REFERENCE FORM. One (1) ATTACHMENT 16: KEY STAFF QUALIFICATIONS FORM must be used for each corresponding ATTACHMENT 17: KEY STAFF REFERENCE FORM submitted. The Key Staff's reference contact must complete the remainder of the form.

The Key Staff's reference contact must have been:

• From the end user of the development project.

• In a management or supervisory role for the project.

The Key Staff's reference contact must not have been:

• From another contractor or contracting company.

• An employee of the bidding company.

• An employee of Water Board Division of Drinking Water or Division of Information Technology

The reference information below must be consistent with the corresponding ATTACHMENT 16: KEY

STAFF QUALIFICATIONS FORM.

The Bidder must submit a completed ATTACHMENT 16: KEY STAFF QUALIFICATIONS FORM and the corresponding ATTACHMENT 17: KEY STAFF REFERENCE FORM to the Key Staff's reference(s) for completion. The reference contact name(s) must have performed a management or supervisory role on the project cited to be considered responsive. References from another contractor or contracting company are not acceptable.

Reference Instructions: Complete Part B, items 10–13 of this attachment, ATTACHMENT 17: KEY STAFF REFERENCE FORM and the signature block. For items 10-13, use the rating scale in the “Reference Rating Scale” field (item 9). Rate your satisfaction with the Key Staff that performed the services described in described on the ATTACHMENT 16:KEY STAFF QUALIFICATIONS FORM.

Provide a Pass or Fail rating value for each question. The supplied Key Staff Qualifications Form describes the provided services for your reference/verification. Complete the signature block with the date, name, title, and contact information and return this form to the bidder.

Note: The Procurement Officer may contact you with your supplied contact information to verify. Please

State of California Department of Technology

RFP 26-014-280

KEY STAFF REFERENCE FORM

October 2, 2026 https://sb.cityinnovate.com/account/solicitations/documents/386443 https://sb.cityinnovate.com/account/solicitations/documents/386444 https://sb.cityinnovate.com/account/solicitations/documents/386443 monitor your email accordingly. If a reference is not permitted either legally or by company/organization policy to sign the Key Staff Reference Form, the reference must type or print its full name on the form and provide a brief statement outlining the reason they are not permitted to sign the Key Staff Reference Form.

PART A: TO BE COMPLETED BY BIDDER

1 Bidder:

2 Key Staff Name:

3 Project Name:

4 Name of Company for whom the Project was completed:

5 Contact Name and Information of the Key Staff's Reference:

6 Key Staff's Start and End Dates on the Project:

7 Contract Amount: $

8 Project Description & Key Staff's role on the project:

State of California Department of Technology

RFP 26-014-280

KEY STAFF REFERENCE FORM

October 2, 2026

PART B: TO BE COMPLETED BY KEY STAFF'S REFERENCE

Reference Rating Scale:

Using the following scale to rate the Key Staff's overall performance on the services provided:

Pass — The Key Staff met your expectations.

Fail — The Key Staff did not meet your expectations.

Circle only one answer for each question (10-13) below.

Reference Ratings

(Pass / Fail)

10 How would you rate the individual’s overall performance? Pass Fail

How would you rate the individual’s effectiveness at communicating (orally and in writing) with project members and stakeholders?

Pass Fail

How would you rate the individual’s effectiveness in dealing with conflicting priorities?

Pass Fail

How would you rate the individual’s effectiveness in the role they were in for the cited project?

Pass Fail

By completing this reference form, I declare the following:

1. I have reviewed the information contained in Part A, items 1–8 above, and the corresponding ATTACHMENT 16: KEY STAFF QUALIFICATIONS FORM and the information is true and correct;

2. I am/was employed by the company for whom the cited project was completed; and

3. I performed a management or supervisory role on the cited project.

TO BE COMPLETED BY PROPOSED KEY STAFF'S REFERENCE

Signature:

State of California Department of Technology

RFP 26-014-280

KEY STAFF REFERENCE FORM

TO BE COMPLETED BY PROPOSED KEY STAFF'S REFERENCE

Printed Name:

Date:

Title or role in the project:

Email:

Phone:

State of California Department of Technology

RFP 26-014-280

KEY STAFF REFERENCE FORM