Att H - Reference Check Form.docx
DOCX document 40 KB Posted
- Attached to
- RFS 26-87982 IVH Hospice CareBid Documents
- Solicitation number
- RFS 26-87982
- Issued by
- Marion County, Indiana
About this file
This is a Reference Check Form issued by the State of Indiana for RFS 26-87982, a competitive solicitation process requiring vendor references as part of the evaluation criteria. The form must be completed by organizations that have previously worked with a responding vendor and submitted to idoareferences@idoa.in.gov by August 21, 2026 at 3:00 PM Eastern Time. References should provide detailed information about their company and contact details, then respond to thirteen evaluation questions designed to assess vendor performance across multiple dimensions.
The reference evaluation covers critical performance areas including the duration and scope of the working relationship, vendor communication with internal and external stakeholders, financial audit compliance, performance corrective actions, quality of services and staff, stakeholder engagement, resource allocation, cost and schedule management, and overall vendor performance. References are asked to rate vendors on a scale of poor, satisfactory, above average, or superior for most questions, with detailed explanations required. The form allows references to decline participation and provides an opportunity for additional comments the State of Indiana should consider during its evaluation process.
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Other files
| File | Type | Posted |
|---|---|---|
| Att K - SOW Template.docx | DOCX document | |
| Att G - Q&A Template.xlsx | XLSX spreadsheet | |
| Att I - Pre-proposal Network Form.docx | DOCX document | |
| Att B - Sample Contract.docx | DOCX document | |
| Att J - Attestation Form.docx | DOCX document | |
| RFS 26-87982 Main Document.pdf | ||
| Att L - Infrastructure Overview.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att M - Artificial Intelligence.docx | DOCX document | |
| Att F - Technical Proposal.docx | DOCX document | |
| Att E - Business Proposal.docx | DOCX document |
Show all 11
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Text version
Attachment H Reference Check Form
RFS 26-87982
Reference Check Form Due Date:
August 21, 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:
RFS 26-87982 Reference – 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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