11-HSS-26-033 - Indigent Burial - Attachment 5 - Business References Form.docx

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Attached to
INDIGENT BURIAL AND CREMATION SERVICES
Solicitation number
HSS-26-033
Issued by
Delaware

About this file

This is a Business References Form attachment for the Delaware Health and Social Services Division of Social Services' contract for indigent burial and cremation services (Contract No. HSS-26-033). The form requires bidders to provide a minimum of three business references that demonstrate relevant experience in the field. Each reference entry must include the business name and mailing address, contact name and phone number, number of years of business association, and type of work performed. Bidders who have held a state contract within the last five years must provide a separate list of those contracts in addition to the standard business references.

The form explicitly prohibits the use of Delaware state employees as business references. Each reference section requests detailed contact information including email and phone/fax numbers, current vendor status, and a description of years associated with the business and the type of work performed. This documentation requirement is designed to verify bidders' qualifications and experience in providing burial and cremation services to support the state's effort to establish a vendor pool for indigent burial and cremation services.

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Text version

Delaware Health and Social Services

Division of Social Services d

Delaware Health and Social Services

Division of Social Services1 d

Attachment 5

CONTRACT NO: HSS-26-033

CONTRACT TITLE: INDIGENT BURIAL AND CREMATION SERVICES

BUSINESS REFERENCES

List a minimum of three business references, including the following information:

· Business Name and Mailing address

· Contact Name and phone number

· Number of years doing business with

· Type of work performed Please do not list any State Employee as a business reference. If you have held a State contract within the last 5 years, please provide a separate list of the contract(s).

1.
Contact Name & Title:

Business Name:

Address:

Email:

Phone # / Fax #:

Current Vendor (YES or NO):

Years Associated & Type of Work Performed:

2.
Contact Name & Title:

Business Name:

Address:

Email:

Phone # / Fax #:

Current Vendor (YES or NO):

Years Associated & Type of Work Performed:

3.
Contact Name & Title:

Business Name:

Address:

Email:

Phone # / Fax #:

Current Vendor (YES or NO):

Years Associated & Type of Work Performed:

STATE OF DELAWARE PERSONNEL MAY NOT BE USED AS REFERENCES.

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