6-HSS-26-013 - Personal Attendant Services - Attachment 5 - Business References Form.docx
DOCX document 138 KB Posted
- Attached to
- PERSONAL ATTENDANT SERVICES (PAS)
- Solicitation number
- HSS-26-013
- Issued by
- Delaware
About this file
This document is a Business References Form for a Personal Attendant Services contract (No. HSS-26-013) issued by the Delaware Health and Social Services Division of Services for Aging and Adults with Physical Disabilities. The form requires bidders to provide a minimum of three business references, including business name, contact information, years of association, and type of work performed. The references cannot include state employees, and vendors with recent state contracts must provide a separate list.
The related state and local contract opportunity involves Personal Attendant Services (PAS), a participant-directed service supporting individuals with disabilities who need assistance with daily living activities. The service allows participants to be common-law employers of their own attendants, with supports potentially including bathing, dressing, personal hygiene, meal preparation, shopping, housekeeping, transportation, communication, and on-the-job functions. Detailed service specifications are referenced in Appendix B (Personal Attendant program) and Appendix C (Support for Participant Direction program).
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Text version
Delaware Health and Social Services
Division of Services for Aging and Adults with Physical Disabilities d
Delaware Health and Social Services
Division of Services for Aging and Adults with Physical Disabilities d
Attachment 5
CONTRACT NO: HSS-26-013
CONTRACT TITLE: Personal Attendant Services
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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