11._CCHCS-MC-415-_Customer_Reference_Questionnaire.pdf

Proposal Number: SD23-00097

Attachment 11

CCHCS-MC-415 – Customer Reference Questionnaire Rev. 06/10/2019

CUSTOMER REFERENCE QUESTIONNAIRE

BIDDER’S NAME: __________________________________________________________________

The California Department of Corrections and Rehabilitation, California Correctional Health Care Services (CCHCS) is conducting a bid for Dialysis services. It is the bidder’s responsibility to furnish a letter of reference with each copy of the Customer Reference Questionnaire. The Customer Reference Questionnaires and letters of reference will be used to evaluate the bidder’s past performance. In order for a bidder to receive consideration, the CCHCS Direct Care Contracts Section Proposal Representative must receive the completed Customer Reference Questionnaires and accompanying letters of reference on or before the date included in the solicitation.

Note: If two Customer Reference Questionnaires and two letters of reference are not received by the proposal deadline, the proposal will be rejected from further consideration.

Customer Reference

Agency/Company Name:

Address:

Contact Person/Title:

Telephone Number:

1. Please list the services the bidder provided to your company:

2. Were there any issues or concerns that needed to be addressed regarding the bidder’s performance?

☐ Yes ☐ No

If yes, what were they and how were they resolved?

3. How long has the bidder performed services for your company? __________________________

4. Approximately how many people are employed by your company? ________________________

5. Please rate the bidder’s ability to respond to requests in a timely manner.

☐ Excellent ☐ More than Adequate ☐ Adequate ☐ Barely Adequate ☐ Inadequate

6. Please rate the bidder’s accessibility, responsiveness, and overall quality of customer service and support.

☐ Excellent ☐ More than Adequate ☐ Adequate ☐ Barely Adequate ☐ Inadequate

Proposal Number: SD23-00097

Attachment 11

CCHCS-MC-415 – Customer Reference Questionnaire Rev. 06/10/2019

7. Please rate the bidder’s overall accuracy, timeliness, and reliability of providing services.

☐ Excellent ☐ More than Adequate ☐ Adequate ☐ Barely Adequate ☐ Inadequate

8. Please rate the bidder’s overall accuracy, completeness, and timeliness of invoicing.

☐ Excellent ☐ More than Adequate ☐ Adequate ☐ Barely Adequate ☐ Inadequate

9. Please rate the bidder’s quality of training provided to your staff (including written instructions).

☐ Excellent ☐ More than Adequate ☐ Adequate ☐ Barely Adequate ☐ Inadequate

Reference Signature: _________________________________________ Date: __________________

Please return the completed Customer Reference Questionnaire and accompanying letter of reference to the following CCHCS Direct Care Contracts Section Proposal Representative.

California Correctional Health Care Services Direct Care Contracts Section

Attention: Kayla Jennings PO Box 588500

Elk Grove, CA 95758 Email Address: Kayla.Jennings@cdcr.ca.gov