Att H - Reference Check Formv2.docx
DOCX document 38 KB Posted
- Attached to
- ISPHN Med Repack and Preventative MaintenanceBid Documents State and local contract opportunity
- Solicitation number
- 26-86417
- Issued by
- Vanderburgh County, Indiana
About this file
This is a Reference Check Form created by the Indiana Department of Administration for the Indiana State Psychiatric Hospital Network (ISPHN) medication repackaging equipment service contract (RFP 26-8493386417). Vendors responding to this solicitation are required to submit completed reference check forms from previous clients by August 31, 2026, at 3:00 PM Eastern Time. The form requests references to provide detailed feedback on vendor performance across multiple dimensions, including service quality, stakeholder communication, staff capabilities, cost and schedule management, and financial audit history. References should be submitted to idoareferences@idoa.in.gov with the subject line clearly identifying the RFP number and company name.
The reference check form contains 13 evaluation questions designed to assess vendor qualifications and past performance in supporting government operations. References are asked to rate vendors on a scale of poor, satisfactory, above average, or superior across categories including quality of services, business knowledge, staff quality, stakeholder engagement, resource allocation, and cost/schedule performance. The form also solicits information regarding any financial audit issues, corrective action requests, and general recommendations for the State's evaluation process. Contact information for the State's Procurement Consultant, Angie Alexander, is provided for any clarifying questions about the reference submission process.
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Text version
Attachment HState of Indiana Contact:
Angie Alexander, Procurement Consultant angalexander@idoa.in.gov Indiana Department of Administration
Reference Check Form
RFP 26-8493386417
Reference Check Form Due Date:
October 3, 2025 August 31, 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 26-86417 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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