Certificate of Experience.pdf

PDF 26 KB Posted

Attached to
RFB-RC-2025-068 DEGREASER-Sewer Grease Liquefying Agent, Fusion 300 or equal
Solicitation number
RFB-ROCKLAND-25-000065
Issued by
Rockland County, New York

About this file

Written by GovTribe AI ·

The document is a Certificate of Experience form issued by the County of Rockland's Department of General Services (DGS) Purchasing Division, located at 50 Sanatorium Rd, Pomona, NY 10970. This form is specifically designed for vendors bidding on the RFB-RC-2025-068 contract for a Sewer Grease Liquefying Agent (Fusion 300 or equal), and must be completed and submitted with the bid. The form requires vendors to provide detailed information about their previous work experience, including the names of businesses, contact information, contract amounts, types of work performed, and contact details for references covering the past three years.

The form is a standard procurement document that helps the County of Rockland evaluate a vendor's qualifications and past performance before awarding a contract. It allows bidders to demonstrate their expertise and track record in similar projects or services. The document provides space for listing up to five previous business references, with fields for comprehensive contact information and contract details. By requiring this certificate, the county can assess the vendor's reliability, capability, and experience in delivering services similar to the requested sewer grease liquefying agent procurement.

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PAGE: 1

COUNTY OF ROCKLAND - DGS-PURCHASING

BLDG. A., 6th FLOOR, 50 SANATORIUM RD, POMONA, NY 10970

TELEPHONE: 845-364-3820 / TELEFAX: 845-364-3809

CERTIFICATE OF EXPERIENCE

(THIS FORM MUST BE COMPLETED BY VENDOR AND SUBMITTED WITH BID)

I _____________________________________________ HEREBY CERTIFY THAT (COMPANY) ____________________________

_____________________________________ HAS PERFORMED THE FOLLOWING WORK WITHIN THE LAST THREE YEARS:

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BUSINESS: ___________________________________ CONTACT NAME: ____________________________________

ADDRESS: ________________________________________________________________________________________________

AMOUNT OF CONTRACT: ________________________________ TELEPHONE NO.: ____________________________________

TYPE OF WORK: _________________________________________EMAIL ADDRESS: __________________________________

FAX NO.: _______________________________________

NAME OF BIDDER: _____________________________________________ BY: ___________________________________________________

TITLE: ________________________________________________________ SIGNATURE_____________________________________________

RF

NAME OF BIDDER: _____________________________________________ BY: ___________________________________________________

I:
HEREBY CERTIFY THAT COMPANY:
HAS PERFORMED THE FOLLOWING WORK WITHIN THE LAST THREE YEARS:
NAME OF BUSINESS:
CONTACT NAME:
ADDRESS:
AMOUNT OF CONTRACT:
TELEPHONE NO:
TYPE OF WORK:
EMAIL ADDRESS:
FAX NO:
NAME OF BUSINESS1:
CONTACT NAME1:
ADDRESS1:
AMOUNT OF CONTRACT1:
TELEPHONE NO1:
TYPE OF WORK1:
EMAIL ADDRESS1:
FAX NO1:
NAME OF BUSINESS2:
CONTACT NAME2:
ADDRESS2:
AMOUNT OF CONTRACT2:
TELEPHONE NO2:
TYPE OF WORK2:
EMAIL ADDRESS2:
FAX NO2:
NAME OF BUSINESS3:
CONTACT NAME3:
ADDRESS3:
AMOUNT OF CONTRACT3:
TELEPHONE NO3:
TYPE OF WORK3:
EMAIL ADDRESS3:
FAX NO3:
NAME OF BUSINESS4:
CONTACT NAME4:
ADDRESS4:
AMOUNT OF CONTRACT4:
TELEPHONE NO4:
TYPE OF WORK4:
EMAIL ADDRESS4:
FAX NO4:
NAME OF BIDDER:
BY:
TITLE:
Text Field0:

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