ESBD_556287_1790181500214_Form 3 - References.pdf

RFP No. 3202600121 Page 1 of 6 Form 3: References (including Cancelled Contract References) v. Dec 2025

Request for Proposal (RFP) Form 3 –

References

3202600121 – CCRC Parking Lot Resurfacing Must Be Completed and Returned.

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 three (3) years, and must be from state, federal, and/or local governmental entities. Do not include TWC as a reference.

By submitting this document, the Respondent releases the below-named companies providing a reference, its agents, employees, and all people, natural or corporate, in privity with above-named company providing a reference from any and all liability, claims or causes of action arising from their disclosure of information pursuant to this request for a business reference.

Respondents are required to complete Section A: Release of Liability, for each Reference.

RFP No. 3202600121 Page 2 of 6

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Reason for contract termination/expiration, if contract is no longer in effect: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Reason for contract termination/expiration, if contract is no longer in effect: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

RFP No. 3202600121 Page 3 of 6

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Reason for contract termination/expiration, if contract is no longer in effect: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

RFP No. 3202600121 Page 4 of 6

Canceled Contracts:

#1-Project 1:

Start Date: Projected Completion Date: Actual Completion Date:

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.

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.

RFP No. 3202600121 Page 5 of 6

#1-Project 1:

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 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? If so, explain. Respondents are not required to violate any confidentiality provision but must provide information not prohibited from disclosure.

Has the Respondent had a project terminated, stopped in the middle, or contract terminated for default or convenience within the past five (5) years? Yes or No. If yes, provide an explanation with details including the others party’s name, address, and telephone number.

RFP No. 3202600121 Page 6 of 6

SECTION A: RELEASE OF LIABILITY

THIS SECTION MUST BE COMPLETED/SIGNED BY RESPONDENT FOR

EACH IDENTIFIED REFERENCE AND SUBMITTED WITH THE

RESPONDENT’S RESPONSE. AN ORIGINAL MUST BE SENT TO THE

REFERENCE BY THE RESPONDENT.

To company providing the reference:

Enter name of company providing the reference here

You are hereby requested to provide a business reference for:

Enter name of company (Respondent) or key staff person’s name needing a reference to the: Texas Workforce Commission Solicitation Evaluation Team

Please disclose any and all information that you deem relevant relating to the above-named parties’ business relationship. By signing this document, the entity and, if applicable, individual key staff person signing below releases the above-named company providing a reference, its agents, employees, and all persons, natural or corporate, in privity with above-named company providing a reference from any and all liability, claims or causes of action arising from their disclosure of information pursuant to this request for a business reference.

Signed the ______________ day of ______________, 20____.

(Respondent Signature)

(Respondent Printed Name)

(Respondent Title)

Signed the ______________ day of ______________, 20____.

Request for Proposal (RFP) Form 3 – References