ESBD_533044_1782848785364_ATTACHMENT G.5 References and Past Project Performance.pdf
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- Solicitation number
- TMD26-SEC-0043346
- Issued by
- Travis County, Austin City, Texas
About this file
This is a References and Past Project Performance form required for submission with a response to solicitation TMD26-MH-0043346 for Clinical Substance Use Disorder Treatment Training issued by the State of Texas. The form mandates that respondents provide a minimum of three references from state, federal, and/or local governmental entities for similar contracts or projects performed within the last five years. For each reference, respondents must document the project description, contact information for the reference, the organization served, contract amounts (original and final), the types of services provided, whether the respondent served as the primary contractor or subcontractor, and the contract start date, projected completion date, and actual completion date.
The form also requires respondents to disclose any sanctions, liquidated damages, or other monetary remedies assessed under existing or past contracts during the previous five years; any threatened, pending, or resolved disciplinary actions for substandard work or unethical practices; any orders, judgments, or decrees from federal or state authorities limiting business rights; any civil or criminal litigation or compromise or settlement agreements related to contract performance; and whether any projects have been terminated, stopped mid-project, or terminated for default or convenience within the past five years. Respondents must provide full details of any affirmative disclosures, including the names, addresses, and telephone numbers of other parties involved. The form explicitly states that TMD cannot be listed as a reference and that respondents must comply with all disclosure requirements except where confidentiality provisions prohibit disclosure.
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FORM 3 – REFERENCES AND PAST PROJECT
PERFORMANCE SHEET
Must Be Completed and Returned with Response.
Solicitation No. TMD____________ & Description ___________
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 the solicitation within the last five (5) years and be from state, federal, and/or local governmental entities. Do Not include TMD as a reference.
#1-Project Description:
Contact Name:
Name of the organization to which the service was provided:
Reason for contract termination/expiration, if contract is no longer in effect:
Contact Number: Contact E-Mail Address:
Original Contract Amount: Final Contract Amount:
Types of services directly provided by the Respondent and whether the Respondent was the contractor or Subcontractor:
#2-Project Description:
Contact Name:
Name of the organization to which the service was provided:
Reason for contract termination/expiration, if contract is no longer in effect:
Original Contract Amount: Final Contract Amount:
Types of services directly provided by the Respondent and whether the Respondent was the contractor or Subcontractor:
#3-Project Description:
Contact Name:
Name of the organization to which the service was provided:
Reason for contract termination/expiration, if contract is no longer in effect:
Contact Number: Contact E-Mail Address:
Original Contract Amount: Final Contract Amount:
Types of services directly provided by the Respondent and whether the Respondent was the contractor or Subcontractor:
Start Date: Projected Completion Date: Actual Completion Date:
The Respondent has been assessed any Sanctions, including liquidated damages or other such monetary remedies, under any existing or past contracts during the last five (5) years, and, if so, note the reason for and the amount assessed or paid for each incident.
The Respondent was 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.
The Respondent has 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 goods and/or services sought by this Solicitation, or that a reasonable person knowledgeable of the applicable industry would consider relevant to the work under the Contract. Respondents are not required to violate any confidentiality provision but must provide information not prohibited from disclosure.
Indicate if your company has had a project terminated, stopped in the middle, contract terminated for default or convenience within the past five
(5) years. Yes or No, If yes, provide explanation full details including the others party’s name, address, and telephone number.
FORM 3 – REFERENCES AND PAST PROJECT PERFORMANCE SHEET
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