4-RFP 06 Request for Client Information Form.pdf
PDF 175 KB Posted
- Attached to
- Pharmacy Inspection Services State and local contract opportunity
- Solicitation number
- RFP26-65
- Issued by
- Los Alamos County, New Mexico
About this file
This is a Request for Client Information Form issued by the Incorporated County of Los Alamos Procurement Division in New Mexico for the Pharmacy Inspection Services solicitation. The form requires offerors to provide detailed information about a minimum of three previous or current clients for whom they have provided similar services within the last three to five years. Each client entry must include the company name, address, contact name and position, email address, telephone number, service dates, a description of services provided, and the outcome of the engagement. The County reserves the right to contact any or all listed clients to verify information and request additional details from the clients directly.
The form accommodates up to five client references and allows offerors to designate previous client information as confidential if necessary; however, failure to provide requested client information may result in lower evaluation scores if client references constitute a scored evaluation criterion. The form does not specify pricing terms, set-asides, funding sources, or contract duration details, as it functions solely as a supplementary document for gathering client reference information as part of the overall bid evaluation process for licensed pharmacist services to provide quarterly pharmaceutical inspections and oversight of drug handling and distribution for the Los Alamos County Emergency Medical Services.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 6-RFP 08 Cost Proposal Worksheet.pdf | ||
| 5-RFP 04 Request for Preference Form.pdf | ||
| 3-RFP 00 Request for Proposal.pdf | ||
| 2-RFP 03 Certification Debarment Suspension Form.pdf | ||
| 1-RFP 01 Sample Services Agreement.pdf | ||
| 9-RFP 05 Verification of Authorized Offeror Form.pdf | ||
| 7-RFP 02 Campaign Contribution Form.pdf | ||
| 8-RFP 07 Agreement Deviations and Exceptions Form.pdf |
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Text version
REQUEST FOR CLIENT
INFORMATION
Incorporated County of Los Alamos Procurement Division
101 Camino Entrada, Building 3 Los Alamos, NM 87544
Version:20250318
Please follow the instructions below to provide information about previous or current clients as requested in this form.
1. The County reserves the right to contact some or all of the clients listed to verify any information provided and to request that they provide additional information.
2. If previous client information is confidential, you may state so; however, if previous or current client information is a scored evaluation criteria, evaluation scores will reflect Offeror’s inability to include some or all of the requested information in the bid or proposal.
3. Provide a minimum of 3 previous or current clients for similar services performed in the last 3-5 years.
4. Information provided should include company name, address, contact name, position, e-mail address, telephone number, the period during which services were provided, a description of the services provided, and outcome of the engagement.
GENERAL INFORMATION
Offeror Company Name:
Solicitation No.:
Solicitation Title:
Name and Title of the Person Completing this Form
PREVIOUS OR CURRENT CLIENT INFORMATION
CLIENT 1
Company Name
Address
Contact Name and Position
E-mail Address
Telephone Number
Period During Which Services Were Provided
MM/DD/YY – MM/DD/YY
Description of Services Provided and Outcome of the Engagement
CLIENT 2
Company Name
Address
Contact Name and Position
E-mail Address
Telephone Number
Period During Which Services Were Provided
MM/DD/YY – MM/DD/YY
CLIENT 3
Address
Contact Name and Position
E-mail Address
Telephone Number
CLIENT 4
Address
Contact Name and Position
E-mail Address
Telephone Number
CLIENT 5
Company Name
Address
Contact Name and Position
E-mail Address
Telephone Number
Period During Which Services Were Provided
MM/DD/YY – MM/DD/YY
| Company Name: |
| Address: |
| Contact Name and Position: |
| Email Address: |
| Telephone Number: |
| Period During Which Services Were Provided MMDDYY MMDDYY: |
| Description of Services Provided and Outcome of the Engagement: |
| Company Name_2: |
| Address_2: |
| Contact Name and Position_2: |
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| Period During Which Services Were Provided MMDDYY MMDDYY_2: |
| Description of Services Provided and Outcome of the Engagement_2: |
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| Period During Which Services Were Provided MMDDYY MMDDYY_4: |
| Description of Services Provided and Outcome of the Engagement_4: |
| Company Name_5: |
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| Contact Name and Position_5: |
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| Period During Which Services Were Provided MMDDYY MMDDYY_5: |
| Description of Services Provided and Outcome of the Engagement_5: |
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