Att H - Reference Check Form.docx
DOCX document 38 KB Posted
- Attached to
- ISPHN Centralized Billing OfficeBid Documents State and local contract opportunity
- Solicitation number
- RFP 26-86529
- Issued by
- Indiana
About this file
This is a Reference Check Form created by the State of Indiana Department of Administration for RFP 26-86529. The form is designed to be completed by references provided by vendors responding to the state solicitation. References must submit completed forms to idoareferences@idoa.in.gov with the subject line clearly stating "RFP 26-86529 Reference - [INSERT COMPANY NAME]." The form requires reference contact information including the company name, contact person, title, mailing address, website, telephone number, fax number, email address, and industry classification.
The form contains thirteen evaluation questions requiring references to assess vendor performance across multiple dimensions. References are asked to provide details on the length of their working relationship with the vendor, communication with internal and external stakeholders, any financial audit issues, corrective action requests, and quality ratings of services, staff knowledge, staff quality, stakeholder engagement, resource availability, and cost/schedule performance. Each rating category offers options of poor, satisfactory, above average, or superior with space for elaboration. References may decline to provide a reference and explain their reasons. The due date for submission is February 25, 2026, at 3:00 PM Eastern Time. State contact for questions is Mike Huth, Procurement Consultant, at jonhuth@idoa.in.gov.
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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 26-86529
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 26-86529 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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