ESBD_460125_1762783224228_Form 3 References Form (1).docx

FORM 3 – REFERENCES AND PAST PROJECT PERFORMANCE SHEET

Must Be Completed and Returned.

3202500192 Child Care Expansion Initiative Program for New Child Care Providers (CCEI Program)

Respondent must provide a minimum of three (3) references who are willing and able to provide documentation about Respondent’s ability to perform similar requested services. These references must relate to similar contracts or projects performed as described in Section 2.2 of the RFP within the last five (5) years, and it is preferable they be from state, federal, and/or local governmental entities.

Please note: This form requires (1) information for references using the Reference Template table and (2) contractual work history information using the separate table after the references.

Reference Template (A list of references must be submitted with the Proposal) Respondent will add additional Reference Template tables as needed to indicate meeting the minimum qualifications as specified in the RFP, Section 5.5, items a and b. Information for each listed reference should be included only in one Reference Template table.

Respondents must provide completed Form 4 Respondent Release of Liability (for Reference) for each reference listed. (See RFP Section 6.2)

Project Description and Project Outcomes:

(1)

Date Services Were Performed (Start and End Dates):

Contact Name:

Name of the organization to which the service was provided:

REFERENCES AND PAST PROJECT PERFORMANCE

Reason for contract termination/expiration, if contract is no longer in effect:

Types of services directly provided by the Respondent and whether the Respondent was the contractor or Subcontractor:

Contractual Work History

Please provide the requested information for the following four (4) items based on the Respondent’s contractual work conducted during the last five (5) years.

1. Has the Respondent been assessed any Sanctions, including liquidated damages or other such monetary remedies, under any existing or past contracts during the last five (5) years? If so, note the reason for and the amount assessed or paid for each incident during the last five (5) years.

2. Was the Respondent the subject of (i) any threatened, pending, or resolved disciplinary action for substandard work and/or unethical practices; or (ii)any order, judgment or decree of any federal or state authority barring, suspending or otherwise limiting the right of the Respondent to engage in any business, practice, or activity, during the last five (5) years? If so, explain.

If the failure to disclose is not learned until a Contract has been awarded to the Successful Respondent, the Contract may be terminated. In the event of such termination, the Successful Respondent shall be liable for all costs associated with the re- procurement, including any increased costs for the services originally awarded.

3. Has the Respondent been involved in any civil or criminal litigation and/or entered into any compromise agreement, settlement agreement, or resulting consent decree or judgements, if applicable, related to contract performance, the services sought by this Solicitation, or that a reasonable person knowledgeable of the applicable industry would consider relevant to the work under the Contract? If so, explain. Respondents are not required to violate any confidentiality provision but must provide information not prohibited from disclosure.

4. Has the Respondent had a project terminated, stopped in the middle, contract terminated for default or convenience within the past five (5) years? If so, provide an explanation with full details, including the other contracted party’s name, address, and telephone number.

If the failure to disclose is not learned until a Contract has been awarded to the Successful Respondent, the Contract may be terminated. In the event of such termination, the Successful Respondent shall be liable for all costs associated with the re- procurement, including any increased costs for the services originally awarded.

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