2-HSS-26-035 - Substance Use Diorder Services- Attachment 5 - Business References Form.docx

DOCX document 127 KB Posted

Attached to
Substance Use Disorder Services
Solicitation number
HSS-26-035
Issued by
Delaware

About this file

This is a Business References Form attachment for Contract No. HSS-26-035, Substance Use Disorder Services, issued by the Delaware Health and Social Services Division of Substance Abuse and Mental Health. The form requires prospective bidders to provide a minimum of three business references that demonstrate relevant experience and capability. Each reference entry must include the business name and mailing address, contact name and phone number, years of business association, and type of work performed. The form includes three blank reference sections with fields for contact name and title, business name, address, email, phone number/fax, current vendor status, and years associated with type of work performed. Bidders who have held a State of Delaware contract within the last five years must provide a separate list of those contracts.

The form explicitly prohibits the listing of any State of Delaware personnel as business references. This requirement ensures that references come from independent external sources that can objectively validate the bidder's qualifications and performance history. The reference form is a standard compliance document designed to verify that prospective vendors have demonstrated experience providing services similar to those outlined in the substance use disorder services contract and can provide verifiable evidence of their capability to perform the required work.

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Delaware Health and Social Services

Division of Substance Abuse and Mental Health d

Delaware Health and Social Services

Division of Substance Abuse and Mental Health d

Attachment 5

Contract No. HSS-26-035 Contract Title: Substance Use Disorder 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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