Attachment D -ReferenceCheckForm.docx

RFP [###-####-##] – [RFP title]

ATTACHMENT F - REFERENCE CHECK FORM

RFP OregonBuys# S-63400-00002859 OPRD# 9086 Attachment D

RESTORATION OF MCGIFFERT LOG LOADER AND 3 SKELETON RAIL CARS DAMAGED IN 242 FIRE

ATTACHMENT D - REFERENCE CHECK FORM

Instruction: Proposer shall complete Part I – References #1-3 below.

PART I – REFERENCES

REFERENCE# 1

Proposer Name

Reference Entity

Reference Primary Contact Name

Reference Secondary Contact Name

Primary Contact Ph #

Secondary Contact Ph #

Primary Contact Email

Secondary Contact Email

REFERENCE# 2

Proposer Name

Reference Entity

Reference Primary Contact Name

Reference Secondary Contact Name

Primary Contact Ph #

Secondary Contact Ph #

Primary Contact Email

Secondary Contact Email

REFERENCE# 3

Proposer Name

Reference Entity

Reference Primary Contact Name

Reference Secondary Contact Name

Primary Contact Ph #

Secondary Contact Ph #

Primary Contact Email

Secondary Contact Email

PLEASE NOTE: DO NOT COMPLETE THE PART II ON THE FOLLOWING PAGE.

The SPC will contact references provided above by Proposer to answer questions and to rate the Proposer’s services on a scale of 0-10 and score each reference, if OPRD determines to rate and score References by using the scale and questions listed in Part II of this form.

PART II – RATING and SCORING (Maximum Total 30 Points – Maximum 10 points per Reference) Rate the following questions on a scale of 0-10: 0 = Not satisfied (0pt) 5 = Moderately satisfied (1pt) 10 = Extremely satisfied (2pts) REFERENCE# 1 Contact Name: ______________________________ Reference Check Date: ___________ Total Pts _______

2. How would you rate the Proposer’s delivery of service?

Rate:________ Comments:

REFERENCE# 2 Contact Name: ______________________________Reference Check Date: ____________ Total Pts _______

2. How would you rate the Proposer’s delivery of service?

Rate:________ Comments:

REFERENCE# 3 Contact Name: ______________________________Reference Check Date: ____________ Total Pts _______

2. How would you rate the Proposer’s delivery of service?

Rate:________ Comments: