4-HSS-26-016 COMPREHENSIVE SUBSTANCE USE PRIMARY PREVENTION SERVICES FOR COMMUNITIES, ADULTS AND YOUTH - Attachment 5 - Business References Form.docx
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- Attached to
- COMPREHENSIVE SUBSTANCE USE PRIMARY PREVENTION SERVICES FOR COMMUNITIES, ADULTS AND YOUTH
- Solicitation number
- HSS-26-016
- Issued by
- Delaware
About this file
This business references form is required for the Delaware Health and Social Services Division of Substance Abuse and Mental Health's comprehensive substance use primary prevention services contract (HSS-26-016). The contract seeks providers to deliver prevention services for communities, adults, and youth through evidence-based strategies including education, information dissemination, environmental approaches, community-based activities, and problem identification and referral. The services aim to prevent substance misuse across the lifespan, reduce risk factors while increasing protective factors, and specifically target tobacco, alcohol, marijuana, and fentanyl-laced substances while building sustainable community-level prevention infrastructure and workforce capacity.
The form requires bidders to provide a minimum of three business references with complete contact information, including business name, mailing address, contact person details, phone numbers, years of business relationship, and types of work performed. State employees are explicitly prohibited from serving as references, and vendors who have held Delaware state contracts within the past five years must provide a separate listing of those contracts. The form emphasizes building prevention capacity through collaboration between the Division of Substance Abuse and Mental Health (serving adults 18+) and the Division of Prevention and Behavioral Health Services (serving youth under 18), ensuring consistent prevention approaches across all age groups in Delaware's behavioral health system.
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Text version
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-26-016 Contract Title: COMPREHENSIVE SUBSTANCE USE PRIMARY PREVENTION SERVICES FOR COMMUNITIES, ADULTS AND YOUTH
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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