3-PD 1.1 Attachment B- Reference Sheet.docx

DOCX document 33 KB Posted

Attached to
Health and Pharmacy Benefits
Solicitation number
RFP 26-008
Issued by
Williamson County, San Antonio City, Texas

About this file

This is a Reference Sheet attachment for a solicitation issued by the City of Round Rock, Texas, for Health and Pharmacy Benefits administration services. The City seeks proposals from firms with experience providing health benefits and prescription drug claims services, including enhanced program recommendations and alternatives through internal or external sources. The City currently operates a self-insured medical and dental benefit program administered by United Healthcare as a Third-Party Administrator, serving approximately 2,400 active employees, retirees, and dependents. The City operates on a fiscal year beginning October 1st through September 30th, with the benefits plan year running January 1st through December 31st, and open enrollment occurring in October annually.

Respondents must complete and submit this Reference Sheet with their solicitation response, providing the names, addresses, telephone numbers, email addresses, and contact information for at least three valid municipal or government agencies, or firms of comparable size that have utilized similar services within the last two years. References from the City of Round Rock are not applicable. The submission must include the solicitation number and respondent's name with the date of submission. References may be checked prior to award, and failure to provide valid references or receipt of negative responses may result in automatic disqualification of the submittal. Failure to provide the required information with the solicitation response may automatically disqualify the response from consideration for award.

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ATTACHMENT B

REFERENCE SHEET

PLEASE COMPLETE AND RETURN THIS FORM WITH THE SOLICITATION RESPONSE

SOLICITATION NUMBER:
RESPONDENT’S NAME:DATE:

Provide the name, address, telephone number and E-MAIL of at least three (3) valid Municipal, Government agencies or firms of comparable size that have utilized services that are similar in type and capacity within the last two (2) years. City of Round Rock references are not applicable. References may be checked prior to award. If references cannot be confirmed or if any negative responses are received it may result in the disqualification of submittal.

1.
Company’s Name
Name of Contact
Title of Contact
E-Mail Address
Present Address
City, State, Zip Code
Telephone Number
( )Fax Number: ( )
2.
Company’s Name
Name of Contact
Title of Contact
E-Mail Address
Present Address
City, State, Zip Code
Telephone Number
( )Fax Number: ( )
3.
Company’s Name
Name of Contact
Title of Contact
E-Mail Address
Present Address
City, State, Zip Code
Telephone Number
( )Fax Number: ( )

FAILURE TO PROVIDE THE REQUIRED INFORMATION WITH THE SOLICITATION RESPONSE MAY AUTOMATICALLY DISQUALIFY THE RESPONSE FROM CONSIDERATION FOR AWARD.

File details come from the government source that posted it. Updated .