Attachment 10
Account Reference Form
22760prb, Recycling and Trash Removal Services (Group 79013)
Instructions:This form must be filled out for each account reference that the vendor is providing. Please provide the information requested in each numbered request in the space provided below. Any Bidder who fails to submit responses to the questions may be deemed nonresponsive and may be denied further consideration for Contract award.
- Bidder’s Name
Enter the name of the bidder in the space below:
Name of Bidder:
- Contract Identification
The bidder shall provide the customer name, contract number and contact information of the customer’s representative who can verify all information provided.
Contact Name:
Job Title:
Phone Number:
Email:
- Type of Facility Serviced
The bidder shall provide the name of the facility serviced, the address of the facility, a description of the type of facility that was serviced (for example school, college, correctional facility, office building, etc.), the number of years that the facility was serviced and either a contract or customer account number.
Facility Name:
Street Address:
City:
County:
Zip Code:
Type of Facility:
Number of years the facility was serviced:
Contract or Customer’s Account Number:
- Service Details
The bidder shall identify the types of recycling and/or trash removal services that were provided and the types of containers that were utilized (for example loose pickup, bins, dumpsters, compactors, roll-offs, etc.) by checking the box in the appropriate category listed below. Please note that this information is used to determine which lots your company is qualified to bid on – See Section 3.1 Qualifications of Prospective Bidders.
Service Category Number / Service Category / RFP Lots / Loose Pickup / Bins / Dumpsters / Compactors / Roll-Offs
1 / Disposal of municipal solid waste in bins, dumpsters or loose pickup / Lots 1 and 4 / ☐ / ☐ / ☐ / ☐ / ☐
2 / Disposal of municipal solid waste in compactors / Lot 2 / ☐ / ☐ / ☐ / ☐ / ☐
3 / Disposal of construction and demolition materials / Lot 3 / ☐ / ☐ / ☐ / ☐ / ☐
4 / Single stream recycling, dual stream recycling or recycling of cardboard, paper, plastics, glass or metal food containers / Lots 5, 6, 7, 8, 9, 10, 11 and 12 / ☐ / ☐ / ☐ / ☐ / ☐
5 / Recycling of scrap steel / Lot 13 / ☐ / ☐ / ☐ / ☐ / ☐
6 / Shredding and Recycling of Mixed Paper / Lot 14 / ☐ / ☐ / ☐ / ☐ / ☐
7 / Composting of either green waste or food waste/organics / Lots 15 and 16 / ☐ / ☐ / ☐ / ☐ / ☐
8 / Recycling of construction and demolition materials / Lot 17 / ☐ / ☐ / ☐ / ☐ / ☐
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22760prb Attachment 10