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REFERENCE QUESTIONNAIRE
The State of Nevada, as a part of the ITB process, requires proposing vendors to submit business
references as required within this document. The purpose of these references is to document the
experience relevant to the scope of work and provide assistance in the evaluation process.
The proposing vendor or subcontractor is required to complete Part A and send the following reference
form to each business reference listed for completion of Part B. The business reference, in turn, is
requested to submit the Reference Form directly to the State of Nevada, Purchasing Division by the
requested deadline for inclusion in the evaluation process. The form and information provided will
become a part of the submitted proposal. The business reference may be contacted for validation of the
response.
WSCA Industrial Supplies
Bid No. 7066
Approved 05/07/02
Revised 08/06/04
Page 28
State of Nevada
Department of Administration
Purchasing Division
515 E. Musser Street, Room 300
Carson City, NV 89701
Kenny C. Guinn
Governor
Greg Smith
Administrator
BID # 7066 REFERENCE QUESTIONNAIRE
FOR:
A Multi -state Contract for Industrial Supplies & Equipment,
Lighting Products, Janitorial Supplies & Equipment
Part A:
(Name of company requesting reference)
❑ As Primary Vendor
❑ As Subcontractor of
Name of Primary Vendor
Part B:
This form is being submitted to your company for completion as a business reference for the company
listed above. This form is to be returned to the State of Nevada, Purchasing Division, via e-mail at
srvpurch@purchasing.state.nv.us or facsimile at (775) 684-0188, no later than September 12, 2005 (a�
5:00 PM and must not be returned to the company requesting the reference.
For questions or concerns regarding this form, please contact the State of Nevada Purchasing Division,
Services Procurement Section by telephone at (775) 684-0170 or by e-mail at
srvpurch@purchasing.state.nv.us. When contacting us, please be sure to include the Invitation to Bid
number listed at the top of this page.
CONFIDENTIAL INFORMATION WHEN COMPLETED
Company providing reference:
Contact name and title/position
Contact telephone number
Contact e-mail address
QUESTIONS:
1. In what capacity have you worked with this vendor in the past?
COMMENTS:
2. How would you rate this firm's knowledge and expertise?
(3 = Excellent; 2 = Satisfactory; 1 = Unsatisfactory; 0 = Unacceptable)
COMMENTS:
3. How would you rate the vendor's flexibility relative to changes in the project scope and timelines?
(3 = Excellent; 2 = Satisfactory; 1 = Unsatisfactory; 0 = Unacceptable)
COMMENTS:
WSCA Industrial Supplies
Bid No. 7066
Approved 05/07/02
Revised 08/06/04
Page 29
4. What is your level of satisfaction with goods provided by the vendor?
(3 = Excellent; 2 = Satisfactory; 1 = Unsatisfactory; 0 = Unacceptable)
COMMENTS:
5. How would you rate the dynamics/interaction between the vendor and your staff?
(3 = Excellent; 2 = Satisfactory; 1 = Unsatisfactory; 0 = Unacceptable)
COMMENTS:
6. Who were the vendor's principal representatives involved in your project and how would you rate them
individually? Would you comment on the skills, knowledge, behaviors or other factors on which you based the
rating?
(3 = Excellent; 2 = Satisfactory; 1 = Unsatisfactory; 0 - Unacceptable)
Name: Rating:
Name: Rating:
Name: Rating:
Name: Rating:
COMMENTS:
7. How satisfied are you with the products developed by the vendor?
(3 = Excellent; 2 = Satisfactory; 1 = Unsatisfactory; 0 = Unacceptable)
COMMENTS:
8. With which aspect(s) of this vendor's goods are you most satisfied?
COMMENTS:
9. With which aspect(s) of this vendor's goods are you least satisfied?
COMMENTS:
10. Would you recommend this vendor's goods to your organization again?
COMMENTS:
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