busreffm.doc

Business Reference Form

Bidder:

RFR Name/Title:

RFR Number:

The bidder must provide (indicate a number) __________ business references.

Reference name:_____________________________________ Contact:

Address: ________________________________________________ Phone: # ( )

Fax/Internet address:

Description and date(s) of commodities and services provided:

Reference name: _______________________________________Contact:

Address: _______________________________________________

Reference name: ______________________________________ Contact:

Address: _______________________________________________

References will be contacted to confirm the bidder’s abilities and qualifications as stated in the bidder’s response. The department may deem the bidder’s response unresponsive if a reference is not obtainable from a listed reference after reasonable attempts.

Sensitivity level - low