Attachment F_Client Reference Form.pdf
PDF 161 KB Posted
- Attached to
- Managed Information Technology Services
- Solicitation number
- RFP-12281
- Issued by
- Polk County, Florida
About this file
The document is a Client Reference Form for RFP# 24-04 for Managed Information Technology Services issued by the Florida Department of Citrus. The form requires the respondent to provide detailed information about three current or past clients to whom they have provided commodities and/or contractual services similar in scope and size within the last five years. The form is designed to allow the Department to contact these references and evaluate the vendor's performance, with the vendor granting permission for the references to discuss their experiences and providing a comprehensive release of liability.
The form includes sections for each reference client to document their name, webpage address, contact information, service period, contract value, and a detailed description of the commodity or service provided. The respondent must also disclose any previous name, ownership, or organizational changes that occurred during the time of service performance. By completing this form, the vendor authorizes the Florida Department of Citrus to use the information for assessing eligibility for contract award, with the understanding that the information may be subject to disclosure under Florida public records laws.
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Text version
RFP# 24-04
Managed Information Technology Services
Attachment F: Client Reference Form 1 of 4
Attachment F: Client Reference Form
The Respondent shall complete and submit this entire form. Using the form(s) provided in this Attachment, Respondent shall identify and include three (3) current and/or past clients, either businesses or governmental agencies, to which the Respondent has provided commodities and/or contractual services of similar scope and size as those identified in the RFP within the last five (5) years.
I, _____________________________________ am the ________________________________ of
(Authorized Representative’s Name) (Title)
_______________________________________, (the “Vendor”), and am authorized to represent and
(Vendor’s Legal Name) contractually bind Vendor. Having been duly sworn, I do hereby:
1. Grant permission to the Florida Department of Citrus (the “Department”) to contact the references listed below at a time and using a method convenient to the Department.
2. Waive any claim, either contractual or otherwise, to confidentiality that exists between the listed Client(s) and Vendor regarding Vendor’s performance under the listed contract(s).
3. Release the Client’s Contact(s), or their successors, or designees, to discuss with, and provide any requested information to, the Department concerning Vendor’s performance under the listed contract(s).
4. Release, forever discharge, and hold harmless the Department and the listed Client(s) from any claim or liability that Vendor may make related to the loss, either real or perceived, that may exist due, in whole or in part, to the Department’s evaluation of the information disclosed by the listed Client(s) regarding Vendor’s performance.
I understand that the purpose of this permission and release is for the Department to evaluate and assess Vendor’s eligibility for Contract Award pursuant to the indicated solicitation, and that any such information provided may be subject to disclosure under Chapter 119, F.S., the Florida Constitution, or other authority.
Signature
Date
Attachment F: Client Reference Form 2 of 4
Client #1
Client Name & Internet Address
Client Name:
Webpage Address:
Client Contact Information
Name:
Title:
Street Address:
City, State, and ZIP:
Email Address:
Telephone Number:
Commodity/Service Details
Period of Services: From: To:
Contract Value:
Commodity/Service Description*
*If Respondent has undergone a change of name, ownership, or organization, the name under which the Respondent operated at the time of performance shall be disclosed in this section.
Attachment F: Client Reference Form 3 of 4
Client #2
Client Name:
Webpage Address:
Client Contact Information
Name:
Title:
Street Address:
City, State, and ZIP:
Email Address:
Telephone Number:
Commodity/Service Details
Period of Services: From: To:
Attachment F: Client Reference Form 4 of 4
Client #3
Client Name:
Webpage Address:
Client Contact Information
Name:
Title:
Street Address:
City, State, and ZIP:
Email Address:
Telephone Number:
Commodity/Service Details
Period of Services: From: To:
File details come from the government source that posted it. Updated .