Att H - Reference Check Form.docx
DOCX document 38 KB Posted
- Attached to
- ISPHN Pharmacy ManagementBid Documents State and local contract opportunity
- Solicitation number
- 26-84336
- Issued by
- Vanderburgh County, Indiana
About this file
This is a Reference Check Form issued by the State of Indiana Department of Administration for RFP 26-84336, a Pharmacy Management solicitation. The form serves as a standardized evaluation tool for vendors responding to the state's competitive procurement process. Vendors are required to submit completed reference check forms from previous clients or project stakeholders to demonstrate their qualifications and performance history. The form must be submitted by March 11, 2026, at 3:00 PM Eastern Time to idoareferences@idoa.in.gov, with the email subject line clearly identifying the RFP number and vendor company name. Kevin March, Procurement Consultant at the Indiana Department of Administration (KMarch@idoa.IN.gov), serves as the state's primary contact for inquiries regarding the reference submission process.
The reference check form requires references to provide detailed information about their experience with the vendor across thirteen evaluation areas, including duration of service engagement, stakeholder communication capabilities, financial audit history, performance issue corrective actions, quality of services, business knowledge, staff quality, stakeholder engagement and communication, resource allocation capability, cost and schedule performance, and overall vendor rating. References are requested to rate vendor performance using a four-tier scale of poor, satisfactory, above average, or superior, with supporting explanations for each rating. The form also allows references to decline participation and explain their reasons. This evaluation mechanism enables the State of Indiana to assess vendor capability, reliability, and past performance before contract award for the pharmacy management services.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| RFP 26-84336 Main Doc - Addendum 1.pdf | ||
| RFP 26-84336 - Addendum 1.docx | DOCX document | |
| Att L - AI Technical Questions.docx | DOCX document | |
| Att I - Pre-proposal Network Form.docx | DOCX document | |
| Att D - Cost Proposal.xlsx | XLSX spreadsheet | |
| Att K - Pharmacy Management Services SOW.docx | DOCX document | |
| Att E - Business Proposal.docx | DOCX document | |
| Att G - Q&A Template.xlsx | XLSX spreadsheet | |
| Att B - Sample Contract.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att F - Technical Proposal.docx | DOCX document | |
| Att M - Infrastructure Overview.docx | DOCX document | |
| Att A1 - IVOSB.docx | DOCX document | |
| Att J - Attestation Form.docx | DOCX document | |
| Att A - MWBE.docx | DOCX document | |
| RFP 26-84336 Main Document.pdf |
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Text version
Attachment HState of Indiana Contact:
Kevin March, Procurement Consultant KMarch@idoa.IN.gov Indiana Department of Administration
Reference Check Form
RFP 26-84336
Pharmacy Management
Reference Check Form Due Date:
March 11, 2026 by 3:00PM Eastern Time
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 26-84336 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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