Att.D_Reference.Check.Form.doc

56 KB Posted

Attached to
Health Prof. Service Program (HPSP)
Solicitation number
S-DASOBO-00012632
Issued by
Oregon

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Written by GovTribe AI ·

This is a Reference Check Form attachment for a Request for Proposal (RFP) related to Program Management Services for Health Professionals' Services Program (HPSP). The form is designed to collect feedback from references who have done business with proposers within the last 5 years. The form must be completed by the reference and included in the proposer's submission materials before the RFP closing date and time.

The form includes six scored questions rated on a scale of 0-5, covering areas such as overall quality of services, working relationship, responsiveness to customer service issues, protection of confidential information, adherence to timelines, and likelihood of future contracts. Additionally, there are two unscored questions seeking feedback on the least and most satisfying aspects of the proposer's services. The form requires basic contact information for both the proposer and the reference, including entity name, contact name, telephone number, and email address.

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RFP [###-####-##] – [RFP title]

ATTACHMENT F - REFERENCE CHECK FORM

RFP - Program Management Services for Health Professionals’ Services Program (HPSP)

Att F

ATTACHMENT D - REFERENCE CHECK FORM

Instructions (All references must have done business with the Proposer within the last 5 years):

1. Proposer will submit a Reference Check Form to its Reference.

2. Reference will complete the Reference Check Form to the best of their ability, return the completed Reference Check Form to Proposer.

3. Proposer will include the completed Reference Check Form with their Proposal materials before the RFP Closing date and time.

Proposer Name:

Reference Entity Name:

Reference Contact Name:

Contact Telephone Number:

Contact Email Address:

Please rate the following questions on a scale of 0-5:

0 = Not satisfied 3 = Moderately satisfied 5 = Extremely satisfied.

1. How would you rate the Proposer’s overall quality of services provided?

Score: __________ Comments: ______________________________________________________________________________

2. How would you rate your overall working relationship with the Proposer?

Score: __________ Comments: _____________________________________________________________________________

3. How would you rate the Proposer’s responsiveness to customer service issues and special requests (e.g., reported problems, changes billing, etc.)?

Score: __________ Comments: ______________________________________________________________________________

4. How would you rate the Proposer’s ability to protect confidential information?

Score: __________ Comments: ______________________________________________________________________________

5. How well did Proposer stay within the proposed timeline?

Score:

Comments:

6. How likely are you to contract with the Proposer in the future?

Score:

Comments:

The following questions are optional feedback and may be used in negotiations when appropriate.

7. With which aspect(s) of Proposer’s services are you the least satisfied?

Unscored Services/comments:

8. With which aspect(s) of Proposer’s services are you the most satisfied?

Unscored Services/comments:

Version 1.0 - November 19, 2014 Version 1.0 - November 19, 2014

File details come from the government source that posted it. Updated .