Att H - Reference Check Form.docx
DOCX document 38 KB Posted
- Attached to
- Hearing Aid Assistance ProgramBid Documents State and local contract opportunity
- Solicitation number
- 400-26-84342
- Issued by
- Indiana
About this file
This document is a Reference Check Form issued by the Indiana Department of Administration (IDOA) for RFP 400-26-84342 related to the Hearing Aid Assistance Fund of Indiana. The reference form is designed to collect detailed feedback from previous vendors who have worked with a potential bidder, with a submission deadline of November 10, 2025. The form requires comprehensive evaluation of a vendor's past performance across multiple dimensions, including service quality, communication, staff capabilities, project management, and overall reliability.
The reference check form consists of 13 detailed questions that solicit qualitative and quantitative assessments from reference contacts, covering areas such as project duration, stakeholder interactions, financial audit history, performance issues, staff quality, communication effectiveness, resource allocation, and cost/schedule management. References are asked to provide ratings ranging from poor to superior for various aspects of the vendor's performance, with opportunities to elaborate on their ratings and share additional comments that might inform the State of Indiana's vendor selection process. The form is to be submitted via email to idoareferences@idoa.in.gov, with specific instructions for email subject line formatting.
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Text version
Attachment HState of Indiana Contact:
Christina Garcia, Strategic Sourcing Analyst Cgarcia@idoa.in.gov Indiana Department of Administration
Reference Check Form
RFP 400-26-84342
Hearing Aid Assistance Fund of Indiana
Reference Check Form Due Date:
November 10, 2025 per RFP Section 1.24 Summary of Milestones
INSTRUCTIONS: You have been asked by the vendor listed below to provide a reference as they are responding the current solicitation with the state of Indiana. This is a standard form created by the State of Indiana and your input is very much appreciated. During this competitive process, a representative from the State of Indiana, may contact you directly for more detail. If you have any questions, please contact the State of Indiana contact listed in the box in the top left side of the form.
Please provide the information requested below and submit this reference check form to:
idoareferences@idoa.in.gov:
The subject line of the email submissions must clearly state the following:
RFP 400-26-84342 Reference – [INSERT COMPANY NAME]
VENDOR NAME
REFERENCE CONTACT INFORMATION
Reference Company Name
Contact Name
Contact Title
Company Mailing Address
Company City, State, Zip
Company Website Address
Contact Telephone Number
Contact Fax Number
Contact Email
Industry of Company
QUESTIONS: Please provide a response to each of the questions listed below regarding the vendor listed above.
1. If you decline to provide a reference, please indicate that below and provide any comments you would be willing to share regarding the reason.
2. How long did you/have you and/or members of your team worked with the vendor? Please provide the specific dates of service.
3. With what type of internal and external stakeholders did the vendor have to communicate with?
4. Has the vendor been cited for any financial audit issues? If you are able to, please describe the issue briefly, and any corrective actions required. Did the vendor ultimately address the issue(s) in a satisfactory manner?
5. Has the vendor been subject to any requests for corrective action to cure performance issues? If you are able to, please describe the issue briefly, and any corrective actions required. Did the vendor ultimately address the issue(s) in a satisfactory manner?
6. Would you rate your experience with the quality of services/work provided by vendor as poor, satisfactory, above average or superior? Please elaborate on why you are giving the vendor this rating.
7. Would you rate the vendor's knowledge of your business as poor, satisfactory, above average or superior? Please elaborate on why you are giving the vendor this rating.
8. Would you rate the overall quality of the vendor’s staff as poor, satisfactory, above average or superior? Please elaborate on why you are giving the vendor this rating.
9. Would you describe the quality of the vendor’s engagement and communication with stakeholders (internal and external) throughout the project as poor, satisfactory, above average or superior? Please elaborate on why you are giving the vendor this rating.
10. Would you rate the vendor’s ability to provide appropriate staff and resources for the project, as needed, at all times as poor, satisfactory, above average or superior? Please elaborate on why you are giving the vendor this rating.
11. Would you rate the vendor's performance regarding cost and/or schedule overruns on the project as poor, satisfactory, above average or superior? Please elaborate on why you are giving the vendor this rating.
12. Are there any other topics you believe Indiana should consider during its reference evaluation or comments you would like to share?
13. Would your overall rating of the vendor be poor, satisfactory, above average or superior?
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