Att H - Reference Check Form.docx

DOCX document 36 KB Posted

Attached to
External Quality Reviews for MCO Programs - FSSABid Documents
Solicitation number
26-87847
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 26-87847. The form is designed to solicit standardized reference information from organizations that have previously worked with vendors responding to this state solicitation. The completed reference check form must be submitted to idoareferences@idoa.in.gov by August 26, 2026 at 3:00 PM Eastern Time, with the subject line clearly identifying the RFP number and vendor company name. The State of Indiana may contact references directly during the competitive evaluation process for additional details regarding vendor performance and qualifications.

The reference form requests comprehensive information about vendor performance across thirteen key evaluation areas, including the duration of the business relationship, stakeholder communication requirements, financial audit history, performance corrective actions, quality of services and work, business knowledge, staff quality, stakeholder engagement and communication, resource availability and staffing capacity, cost and schedule management, and overall vendor performance rating. References are requested to rate vendors on a scale of poor, satisfactory, above average, or superior for most evaluation criteria and to provide detailed explanations supporting their ratings. Kristine Kruger, Procurement Specialist at the Indiana Department of Administration, serves as the state point of contact for inquiries regarding the reference check process.

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Text version

Attachment H Reference Check Form

RFP 26-87847

Reference Check Form Due Date:

August 26, 2026 @ 03:00PM 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 direct your inquiries to the State of Indiana representative listed on the bottom right of this 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 26-87847 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

State of Indiana Contact:

Kristine Kruger, Procurement Specialist Krkruger@idoa.in.gov Indiana Department of Administration

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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