25-8426_Form_5_Reference_Questionnaire.pdf
PDF 296 KB Posted
- Attached to
- Collection Agency Services
- Solicitation number
- 25-8426
- Issued by
- Collier County, Florida
About this file
This is a Reference Questionnaire form issued by Collier County, Florida, Emergency Medical Services Division for use in the competitive sealed proposal process for Collection Agency Services (RFP 25-8426). The form requires proposers to submit one completed questionnaire for each required reference, with references rated by past clients on ten evaluation criteria using a 1-10 scale, where 10 indicates very satisfied and 1 indicates very unsatisfied. The questionnaire requests project description, completion date, project budget, and project duration, and evaluates the firm's performance across cost management, schedule adherence, work quality, consultative advice, personnel management, project administration, communication, risk management, contract compliance, and overall customer satisfaction. All reference questionnaires must be fully completed and returned with the bid or proposal submittal by the March 12, 2026, 3:00 PM EST deadline.
The County seeks a qualified collection agency to manage approximately 10,500 delinquent and non-deliverable accounts totaling approximately $8.8 million in annual receivables, with monthly placements averaging $550,000 to $1,418,000. The selected vendor will serve an initial three-year term with two optional one-year renewal periods, with pricing remaining firm during the initial term and future adjustments limited to no more than 3% annually or the Consumer Price Index for all Urban Consumers (CPI-U) for the Miami-Fort Lauderdale area, whichever is less. The County has historically spent approximately $940,000 annually on collection agency services. Proposers must comply with the Fair Debt Collection Practices Act, Florida Consumer Collection Practices Act, HIPAA requirements, PCI DSS compliance standards, and maintain appropriate Florida collection agency licensing. Mandatory compliance requirements include Florida Division of Corporations registration, E-Verify enrollment, a valid Florida Certificate of Authority to Conduct Business, and submission of required certifications and insurance documentation, including Worker's Compensation, Commercial General Liability of $1,000,000 single limit, and Cyber Liability coverage.
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Text version
Version 2 9.2.25
Form 5 Reference Questionnaire
(USE ONE FORM FOR EACH REQUIRED REFERENCE – FORM MUST BE FULLY COMPLETED AND RETURNED
WITH BID/PROPOSAL SUBMITTAL)
Solicitation:
Reference Questionnaire for:
(Name of Company Requesting Reference Information)
(Name of Individuals Requesting Reference Information)
Name:
(Evaluator completing reference questionnaire)
Company:
(Evaluator’s Company completing reference)
Email: FAX: Telephone:
Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.”
Project Description: ___________________________ Completion Date: _____________________________
Project Budget: _______________________________ Project Number of Days: _______________________
Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope).
2 Ability to maintain project schedule (complete on-time or early).
3 Quality of work.
4 Quality of consultative advice provided on the project.
5 Professionalism and ability to manage personnel.
6 Project administration (completed documents, final invoice, final product turnover;
invoices; manuals or going forward documentation, etc.)
7 Ability to verbally communicate and document information clearly and succinctly.
8 Abiltity to manage risks and unexpected project circumstances.
9 Ability to follow contract documents, policies, procedures, rules, regulations, etc.
10 Overall comfort level with hiring the company in the future (customer satisfaction).
TOTAL SCORE OF ALL ITEMS
| Text25: |
| Text26: |
| Name of Company Requesting Reference Information: |
| Text27: |
| Text28: |
| Text29: |
| Text30: |
| Text31: |
| Project Description: |
| Completion Date: |
| Project Budget: |
| Project Number of Days: |
| Score must be completedAbility to manage the project costs minimize change orders to scope: |
| Score must be completedAbility to maintain project schedule complete ontime or early: |
| Score must be completedQuality of work: |
| Score must be completedQuality of consultative advice provided on the project: |
| Score must be completedProfessionalism and ability to manage personnel: |
| Score must be completedProject administration completed documents final invoice final product turnover invoices manuals or going forward documentation etc: |
| Score must be completedAbility to verbally communicate and document information clearly and succinctly: |
| Score must be completedAbiltity to manage risks and unexpected project circumstances: |
| Score must be completedAbility to follow contract documents policies procedures rules regulations etc: |
| Score must be completedOverall comfort level with hiring the company in the future customer satisfaction: |
| Score must be completedTOTAL SCORE OF ALL ITEMS: |
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