Att H - Reference Check Form - rtp.docx
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- Solicitation number
- RFP 26-85965
- Issued by
- Marion County, Indiana
About this file
This is a Reference Check Form created by the Indiana Department of Administration for RFP 26-85965, a solicitation for Wisewoman & INBCCP Data Management & Claims Adjudication services. The form is intended to be completed by references provided by vendors responding to the state's competitive solicitation. Reference check forms must be submitted to idoareferences@idoa.in.gov with the subject line clearly stating "RFP 26-85965 Reference - [VENDOR NAME]" by the due date of May 28, 2026 at 3:00 PM Eastern Time. References must provide their company information, contact details, and information about the industry in which they operate.
The Reference Check Form requests detailed information across thirteen evaluation questions designed to assess vendor performance across multiple dimensions. References are asked to evaluate the vendor's quality of services, business knowledge, staff quality, stakeholder engagement and communication, resource allocation, cost and schedule management, and any history of financial audit issues or corrective action requests. The form also requests information on the duration of the reference's working relationship with the vendor and the types of stakeholders with whom the vendor interacted. References have the option to decline participation and may provide additional comments or topics they believe Indiana should consider during its evaluation process. The completed form serves as a critical component of the state's vendor evaluation and selection process.
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Attachment HState of Indiana Contact:
Angie Alexander Procurement Consultant angalexander@idoa.in.gov Indiana Department of Administration
Reference Check Form RFP 26-85965 – Wisewoman & INBCCP Data Mgmt & Claims Adjudication
Reference Check Form Due Date:
May 28, 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 26-85965 Reference – [INSERT THE VENDOR NAME OF THE VENDOR BEING REFERENCED]
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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