Att H - Reference Check Form.docx
DOCX document 38 KB Posted
- Attached to
- DMHA CCBHC Center of ExcellenceBid Documents
- Solicitation number
- 26-85938
- Issued by
- Marion County, Indiana
About this file
This is a Reference Check Form issued by the State of Indiana Department of Administration for RFP 26-85938, a CCBHC Center of Excellence solicitation. The form is to be completed by references provided by vendors responding to this competitive solicitation. Reference Check Forms are due by February 25, 2026 at 3:00 PM Eastern Time and must be submitted to idoareferences@idoa.in.gov with the subject line clearly stating "RFP 26-85938 CCBHC Center of Excellence Reference - [INSERT COMPANY NAME]." Inquiries regarding the form should be directed to Mike Huth, Procurement Consultant, at jonhuth@idoa.in.gov.
The Reference Check Form requires references to provide vendor contact information, identify the reference company and contact details, and answer thirteen evaluation questions. These questions assess the vendor's performance across multiple dimensions, including the duration of the working relationship, stakeholder communication, financial audit history, corrective action requests, quality of services and staff, business knowledge, engagement and communication with stakeholders, ability to provide appropriate resources, cost and schedule performance, and any additional considerations the State of Indiana should evaluate. References may decline to provide information and are requested to provide specific details and elaboration for each rating category, which use a four-point scale of poor, satisfactory, above average, or superior.
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Text version
Attachment HState of Indiana Contact:
Mike Huth, Procurement Consultant jonhuth@idoa.in.gov Indiana Department of Administration
Reference Check Form
RFP 26-85938
Reference Check Form Due Date:
February 25, 2026 @ 3:00 PM Eastern Time
INSTRUCTIONS: You have been asked by the vendor listed below to provide a reference as they are responding to 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 26-85938 CCBHC Center of Excellence 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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