5-Attachment E - Experience Form.docx
DOCX document 19 KB Posted
- Solicitation number
- KJ02242026
- Issued by
- Harris County, Texas
About this file
This is an Experience Form (Attachment E) associated with Harris Health's Request for Offers (RFO) for Primary Care Services for HIV/AIDS Geriatric Patients in Texas. The form requires bidders to document relevant experience through four client references, with services provided within the last three years. For each client listed, vendors must provide the organization name, contact information, service dates, and detailed descriptions of services rendered. The form specifically requests that bidders identify whether clients are healthcare organizations or hospital systems and explain how each organization is similar to Harris Health, establishing the relevance of the proposed vendor's experience to the healthcare services sought.
The Experience Form serves as a qualification and evaluation tool to assess vendor capability and prior performance in healthcare service delivery. Bidders must demonstrate substantive experience working with healthcare entities comparable to Harris Health, positioning this as a critical document in the vendor selection process. The requirement for current contact information and recent service examples (within three years) ensures that Harris Health can verify references and evaluate the vendor's demonstrated expertise in providing primary care services, particularly for specialized patient populations such as HIV/AIDS geriatric patients.
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Text version
ATTACHMENT E – EXPERIENCE FORM
Examples provided should be for services rendered within the last three (3) years.
Client #1
Organization Name:
Contact Name/Telephone No.:
E-mail Address:
Address:
Dates services began and ended: (Month/Year to Month/Year or present) Is this client a healthcare organization or hospital system? (Yes/No, if Yes, which) What makes this organization similar to Harris Health?
Please describe in detail what kind of services were rendered:
Client #2
Organization Name:
Contact Name/Telephone No.:
E-mail Address:
Address:
Dates services began and ended: (Month/Year to Month/Year or present) Is this client a healthcare organization or hospital system? (Yes/No, if Yes, which)
Client #3
Contact Name/Telephone No.:
E-mail Address:
Address:
Dates services began and ended: (Month/Year to Month/Year or present) Is this client a healthcare organization or hospital system? (Yes/No, if Yes, which)
Client #4
Contact Name/Telephone No.:
E-mail Address:
Address:
Dates services began and ended: (Month/Year to Month/Year or present) Is this client a healthcare organization or hospital system? (Yes/No, if Yes, which)
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