Attachment A References Form.docx
DOCX document 28 KB Posted
- Attached to
- VPA HIP 6 Projects
- Solicitation number
- 82230
- Issued by
- Brunswick County, Virginia
About this file
This is a References Form (Attachment A) for a Virginia Department of Wildlife Resources contract opportunity for Habitat and Infrastructure Projects in Southwest Virginia. The form requires vendors to provide details for at least four current or recent accounts where they have provided similar site alteration services. Each reference must include the company name, contact information, services provided, site size in acres, completion date, and project value.
The form requires detailed information for each reference, including specific measurements for sites less than one acre (to be listed in tenths), and must be signed by an authorized representative certifying the accuracy of the information. The completed form with all four references and certification signature must be included with the bid submission. This document appears to be part of the vendor qualification requirements for the VPA HIP 6 Projects contract, which focuses on habitat and infrastructure improvements on private lands.
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Text version
References Sheet
Indicate below a listing of at least four (4) current or recent accounts, either commercial or governmental, that your company has provided similar services. Include the length of service and the name, address, and telephone number of the point of contact.
| A. |
| Company Name that you provided site alteration services for: |
Contact Name:
Phone Number
Fax Number
Services provided
Size of site in acres if less than 1 acre use tenths
Date of completion of order (insert date: month day year)
$ Value of the project:
| b |
| Company Name that you provided site alteration services for: |
Contact Name:
Phone Number
Fax Number
Services provided
Size of site in acres if less than 1 acre use tenths
Date of completion of order (insert date: month day year)
$ Value of the project:
| C. |
| Company Name that you provided site alteration services for: |
Contact Name:
Phone Number
Fax Number
Services provided
Size of site in acres if less than 1 acre use tenths
Date of completion of order (insert date: month day year)
$ Value of the project:
Required vendor reference information continues on to the next page.
| D. |
| Company Name that you provided site alteration services for: |
Contact Name:
Phone Number
Fax Number
Services provided
Size of site in acres if less than 1 acre use tenths
Date of completion of order (insert date: month day year)
$ Value of the project:
Required vendor reference information continues on to the next page.
IMPORTANT: Certification of this data and your signature is required on the next page certifying the accuracy of this information.
IMPORTANT: Certification of this data and your signature is required below:
I certify the accuracy of this information.
Signature
Printed name of person signing
Title of person signing
Date signed
IMPORTANT: The completed reference forms (four reference) and this signature form above certifying the correct information must be completed and attached to your firm’s bid submission.
File details come from the government source that posted it. Updated .