6-Attachment E - Experience Form.docx
DOCX document 19 KB Posted
- Attached to
- RFO - Workers Compensation Claims Consultant
- Solicitation number
- KJ02122026
- Issued by
- Harris County, Texas
About this file
This is an Experience Form attachment for a Request for Offers (RFO) issued by Harris Health in Texas for Workers Compensation Claims Consultant services. The form requires bidders to document their relevant experience by providing detailed information on up to four client references from the preceding three years. For each client, respondents must supply the organization name, primary contact information including name, telephone number, and email address, the organization's physical address, and the specific dates during which services were provided.
The form requires bidders to identify whether each reference client is a healthcare organization or hospital system and, if applicable, specify which one. Respondents must explain what characteristics make each reference organization similar to Harris Health and provide a detailed description of the specific services rendered to that client. This structured approach allows Harris Health to evaluate the consultant's direct experience with comparable healthcare entities and assess the relevance of their prior work to the scope of workers compensation claims consulting services being procured.
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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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