Contractor Reference form (38).pdf

PDF 135 KB Posted

Attached to
Transportation Special Purpose Local Option Sales Tax (T-SPLOST)
Solicitation number
PE-64800-NONST-2026-000000065
Issued by
Georgia

About this file

This is a Contractor Reference and Release Form issued by the Douglas County Board of Commissioners, Purchasing Department, located in Douglasville, Georgia, in connection with a Request for Qualifications (RFQ) for Transportation Special Purpose Local Option Sales Tax (T-SPLOST) projects. The form requires interested contractors to provide at least three professional references from recent clients, including company names, contact names, addresses, email addresses, and telephone numbers that can verify the respondent's experience and ability to perform the types of services specified in the solicitation. The form must be completed and signed by an authorized company representative with a date of signature.

The form serves as a standard qualification verification document and does not contain specific pricing terms, set-asides, funding amounts, or contract duration details. It functions as a prerequisite submission requirement for firms seeking to provide services related to transportation improvement projects funded through T-SPLOST in Douglas County, Georgia. The references listed on the form will be contacted to substantiate the contractor's qualifications and past performance capabilities for the transportation projects under consideration.

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Text version

CONTRACTOR REFERENCE AND RELEASE FORM

List below at least three recent different (3) references, including company name, contact name, address, email address and telephone numbers who can verify your experience and ability to perform the type(s) of product(s)/ service(s) listed in the solicitation.

Reference No. 1

Contact Name:

Contact Company:

Address:

Phone Number: Email Address:

Reference No. 2

Contact Company:

Reference No. 3

Contact Company:

Name of Authorized Company Representative (Type or Print Legibly):_____________________________

Signature of Authorized Company Representative____________________________________________

Date Signed _________________________________________________________________________

Douglas County Board of Commissioners 8700 Hospital Drive, Purchasing Department, Douglasville, GA 30134

Contact Name:
Contact Company 1:
Contact Company 2:
Phone Number:
Email Address:
Contact Name_2:
Contact Company 1_2:
Contact Company 2_2:
Phone Number_2:
Email Address_2:
Contact Name_3:
Contact Company 1_3:
Contact Company 2_3:
Phone Number_3:
Email Address_3:
Name of Authorized Company Representative Type or Print Legibly:
Date Signed:

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