Attachment B Reference Form.pdf
PDF 213 KB Posted
- Attached to
- Senior Community Service Employement Program
- Solicitation number
- RFP-11545
- Issued by
- Leon County, Florida
About this file
This is a Reference Form (Attachment B) from the Florida Department of Elder Affairs (DOEA) Solicitation No. 24-RFP-001-JT for the Senior Community Service Employment Program. The form requires respondents to provide a minimum of four separate and verifiable references, excluding DOEA, for similar work performed continuously for at least two years. Each reference must include company information, primary and alternate contact details, description of work performed, service dates, and approximate contract value. DOEA will select a minimum of three references to contact at their discretion.
The form specifies that confidential references are not permitted, and DOEA work cannot be listed as a reference. The same reference organization cannot be listed multiple times, even if different divisions or districts were served. The form requires respondents to list all names under which they have ever operated and must be signed by an authorized representative with binding authority. No specific pricing terms or set-aside requirements are mentioned in this document.
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Text version
DOEA Solicitation No.: 24-RFP-001-
JT Page 1 of 2
ATTACHMENT B
REFERENCE FORM
Respondent’s Name:
The Respondent must list a minimum of four (4) separate and verifiable references, other than DOEA, for which work similar to that specified in this solicitation has been performed for a period of at least two (2) continuous years. Any information not submitted on this attachment shall not be considered. The references listed shall be for services similar in nature to that described in this solicitation. The same reference may not be listed as more than one (1) reference (for example, if the Respondent has completed one project for the Florida Department of Transportation – District One and one project for the Florida Department of Transportation – District Two, only one (1) of the projects may be listed because the reference, the Florida Department of Transportation, is the same). DOEA shall choose a minimum of three (3) references at its discretion to contact. Confidential references shall not be included. DO NOT LIST DOEA WORK ON THIS
FORM. (Please provide at least two (2) Contact Names for each company.)
Company Name:
Address:
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Alternate Contact Name:
Alternate Contact Title:
Phone:
Email:
Description of Work:
Service Dates: Dates must demonstrate at least two (2) continuous years
To
Approximate Contract Value: $
Company Name:
Address:
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Alternate Contact Name:
Alternate Contact Title:
Phone:
Email:
Description of Work:
Service Dates: Dates must demonstrate at least two (2) continuous years
To
Approximate Contract Value: $
DOEA Solicitation No.: 24-RFP-001-
JT Page 2 of 2
Company Name:
Address:
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Alternate Contact Name:
Alternate Contact Title:
Phone:
Email:
Description of Work:
Service Dates: Dates must demonstrate at least two (2) continuous years
To
Approximate Contract Value: $
Company Name:
Address:
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Alternate Contact Name:
Alternate Contact Title:
Phone:
Email:
Description of Work:
Service Dates: Dates must demonstrate at least two (2) continuous years
To
Approximate Contract Value: $
List all the names under which Respondent has ever operated.
*Authorized Representative’s Signature
*Typed Name and Title of Authorized Representative
*This individual must have the authority to bind the Respondent.
File details come from the government source that posted it. Updated .