RFP 25-03_Attachment F.pdf
PDF 161 KB Posted
- Attached to
- Low-Code Application Development Services
- Solicitation number
- RFP-15318
- Issued by
- Polk County, Florida
About this file
Client Reference Form Summary
This is a Client Reference Form (Attachment F) for RFP 25-03 Low-Code Application Development Services issued by the Florida Department of Citrus. The form requires respondents to identify and provide three current and/or past client references—either businesses or governmental agencies—to which the respondent has provided commodities and/or contractual services of similar scope and size within the last five years. For each client reference, respondents must supply the client name and webpage address, contact information (name, title, street address, city/state/ZIP, email, and telephone), period of services, contract value, and a description of the commodity or service provided. An authorized representative of the vendor must sign and date the form, granting the Florida Department of Citrus permission to contact references, waiving confidentiality claims, and releasing both the Department and client contacts from liability related to the evaluation of vendor performance information. The form includes a sworn statement authorizing the signatory to represent and contractually bind the vendor.
The reference evaluation serves as part of the RFP's Past Performance scoring criterion, which allocates 200 of the total 1,000 evaluation points. All provided information may be subject to disclosure under Florida Statute Chapter 119, the Florida Constitution, or other applicable authority. The form must be completed in its entirety and submitted as part of the vendor's proposal response to demonstrate organizational capability and successful execution of similar low-code application development projects on the Microsoft Power Platform and Azure technology stack.
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Text version
RFP 25-03
Low-Code Application Development Services
Attachment F: Client Reference Form 1 of 4
Attachment F: Client Reference Form
The Respondent shall complete and submit this entire form. Using the form(s) provided in this Attachment, Respondent shall identify and include three (3) current and/or past clients, either businesses or governmental agencies, to which the Respondent has provided commodities and/or contractual services of similar scope and size as those identified in the RFP within the last five (5) years.
I, _____________________________________ am the ________________________________ of
(Authorized Representative’s Name) (Title)
_______________________________________, (the “Vendor”), and am authorized to represent and
(Vendor’s Legal Name) contractually bind Vendor. Having been duly sworn, I do hereby:
1. Grant permission to the Florida Department of Citrus (the “Department”) to contact the references listed below at a time and using a method convenient to the Department.
2. Waive any claim, either contractual or otherwise, to confidentiality that exists between the listed Client(s) and Vendor regarding Vendor’s performance under the listed contract(s).
3. Release the Client’s Contact(s), or their successors, or designees, to discuss with, and provide any requested information to, the Department concerning Vendor’s performance under the listed contract(s).
4. Release, forever discharge, and hold harmless the Department and the listed Client(s) from any claim or liability that Vendor may make related to the loss, either real or perceived, that may exist due, in whole or in part, to the Department’s evaluation of the information disclosed by the listed Client(s) regarding Vendor’s performance.
I understand that the purpose of this permission and release is for the Department to evaluate and assess Vendor’s eligibility for Contract Award pursuant to the indicated solicitation, and that any such information provided may be subject to disclosure under Chapter 119, F.S., the Florida Constitution, or other authority.
Signature
Date
Attachment F: Client Reference Form 2 of 4
Client #1
Client Name & Internet Address
Client Name:
Webpage Address:
Client Contact Information
Name:
Title:
Street Address:
City, State, and ZIP:
Email Address:
Telephone Number:
Commodity/Service Details
Period of Services: From: To:
Contract Value:
Commodity/Service Description*
*If Respondent has undergone a change of name, ownership, or organization, the name under which the Respondent operated at the time of performance shall be disclosed in this section.
Attachment F: Client Reference Form 3 of 4
Client #2
Client Name:
Webpage Address:
Client Contact Information
Name:
Title:
Street Address:
City, State, and ZIP:
Email Address:
Telephone Number:
Commodity/Service Details
Period of Services: From: To:
Attachment F: Client Reference Form 4 of 4
Client #3
Client Name:
Webpage Address:
Client Contact Information
Name:
Title:
Street Address:
City, State, and ZIP:
Email Address:
Telephone Number:
Commodity/Service Details
Period of Services: From: To:
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