Contractor Reference form (59).pdf

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Attached to
Public Health Building Renovation
Solicitation number
PE-64800-NONST-2026-000000083
Issued by
Douglas County, Georgia

About this file

This is a Contractor Reference and Release Form required by the Douglas County Board of Commissioners, Purchasing Department, located in Douglasville, Georgia, for the Public Health Building Renovation project. The form mandates that bidders submit at least three recent professional references, each including the contact name, company name, address, email address, and telephone number of individuals who can verify the bidder's experience and ability to perform the products or services specified in the solicitation. The references must demonstrate the bidder's capability to execute design, permitting, site preparation, expansion, and remodel services for the Douglas County Public Health Center renovation project located at 6770 Selman Drive, Douglasville, Georgia.

The form requires an authorized company representative to sign and date the submission after providing legible contact information for the organization. This reference verification process is part of Douglas County's evaluation criteria to ensure that responding design-builders possess demonstrated experience and technical qualifications for this capital project, which will be funded through a combination of Cobb & Douglas Public Health reserve funds and appropriations from the Douglas County Board of Commissioners General Fund. The Design-Builder selected will be responsible for all design, permitting, site preparation, expansion, and remodel work in full compliance with applicable federal, state, and local laws, regulations, ordinances, and codes.

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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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