26-HR09 RFP Form D.PDF
PDF 133 KB Posted
- Attached to
- HEALTH INSURANCE AND BENEFIT BROKER
- Solicitation number
- 26-HR09
- Issued by
- Dane County, Wisconsin
About this file
Form D is a references form required for submission with responses to RFP 26-HR09, a health insurance and benefits broker solicitation issued by a Wisconsin city for the 2027-2029 contract period. Respondents must complete the form by providing detailed information for up to six client references, including the client company name, primary contact information, contract period, year completed, total cost, and a description of work performed for each reference.
The form serves as a qualification and evaluation document, allowing the city to verify the bidder's experience and capability in delivering health insurance and benefits brokerage services. Applicants are expected to provide references from comparable engagements that demonstrate their relevant experience and track record of successful project completion. No specific submission deadline, site visit requirements, or award date information is contained within this reference form itself.
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Other files
| File | Type | Posted |
|---|---|---|
| 26-HR09 RFP Form B.PDF | ||
| City of Sun Prairie 2026 Renewal Folder.pdf | ||
| 26-HR09 RFP.PDF | ||
| 26-HR09 RFP Form F.PDF | ||
| 26-HR09 Draft Contract.PDF | ||
| 26-HR09 Appendix A.PDF | ||
| 26-HR09 RFP Form E.PDF | ||
| 26-HR09 RFP Form C.PDF | ||
| 26-HR09 QA FORM.PDF | ||
| City of Sun Prairie 2025 Renewal Folder.pdf | ||
| 26-HR09 RFP Form A.PDF | ||
| 26-HR09 RFP Form G.PDF | ||
| Census Data.xlsx | XLSX spreadsheet |
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Text version
This form must be returned with your response.
Reference # 1 – Client Information Company Name
Contact Name
Address City State Zip
Telephone Number Fax Number
Contract Period Year Completed Total Cost
Description of the Performed Work
Reference # 2 – Client Information Company Name
Contact Name
Address City State Zip
Telephone Number Fax Number
Contract Period Year Completed Total Cost
Description of the Performed Work
Form D: References
RFP #: 26-HR09
Reference # 3 – Client Information Company Name
Contact Name
Address City State Zip
Telephone Number Fax Number
Contract Period Year Completed Total Cost
Description of the Performed Work
Reference # 4 – Client Information Company Name
Contact Name
Address City State Zip
Telephone Number Fax Number
Contract Period Year Completed Total Cost
Description of the Performed Work
Reference # 5 – Client Information Company Name
Contact Name
Address City State Zip
Telephone Number Fax Number
Contract Period Year Completed Total Cost
Description of the Performed Work
Reference # 6 – Client Information Company Name
Contact Name
Address City State Zip
Telephone Number Fax Number
Contract Period Year Completed Total Cost
Description of the Performed Work
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