Attachment C Reference Form_1.docx
DOCX document 38 KB Posted
- Attached to
- DPH | Radiology Registry
- Solicitation number
- SFGOV-0000012046
- Issued by
- San Francisco County, California
About this file
This is a Reference Form attachment for a Request for Proposals issued by the San Francisco Department of Public Health (SFGOV-0000012046) for a Radiology Registry contract. The proposal seeks qualified firms to provide professional temporary radiology technologists and radiology support staff to the San Francisco Health Network, including Zuckerberg San Francisco General Hospital & Trauma Center, Laguna Honda Hospital, Jail Health Services, and SFHN Ambulatory Care sites. All referred staff must be credentialed and competent according to the Scope of Work requirements. The RFP was published on September 2, 2026, with a deadline for questions on September 8, 2026 and an estimated Q&A addendum posting on September 11, 2026. Proposals are due by 2:00 PM PT on September 16, 2026, with an estimated award announcement in October 2026, Health Commission presentation in December 2026, and an estimated contract start date of January 1, 2027.
The Reference Form requires proposers to submit three professional references documenting prior experience providing similar products or services, with each reference including the firm name, organization name, contact information, contract effective and end dates, contract value, and a description of products or services provided. This completed form must be included as part of Electronic File #2 of the proposal submission. All fields on the form are mandatory for submission.
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Attachment C Reference Form Request for Proposals SFGOV- 0000012046 Radiology Registry All fields are required. This form must be completed and included with Electronic File #2.
Reference 1 Name of Firm that Provided Products/Services to Reference (Prime or Subcontractor's Name): Click or tap here to enter text.
Organization Name: Click or tap here to enter text.
Contact Name and Title: Click or tap here to enter text.
Email: Click or tap here to enter text.
Phone Number: Click or tap here to enter text.
Effective Date of Contract: Click or tap here to enter text.
End Date of Contract: Click or tap here to enter text.
Value of Contract: Click or tap here to enter text.
Description of Products/Services Provided: Click or tap here to enter text.
Reference 2 Name of Firm that Provided Products/Services to Reference (Prime or Subcontractor's Name): Click or tap here to enter text.
Organization Name: Click or tap here to enter text.
Contact Name and Title: Click or tap here to enter text.
Email: Click or tap here to enter text.
Phone Number: Click or tap here to enter text.
Effective Date of Contract: Click or tap here to enter text.
End Date of Contract: Click or tap here to enter text.
Value of Contract: Click or tap here to enter text.
Description of Products/Services Provided: Click or tap here to enter text.
Reference 3 Name of Firm that Provided Products/Services to Reference (Prime or Subcontractor's Name): Click or tap here to enter text.
Organization Name: Click or tap here to enter text.
Contact Name and Title: Click or tap here to enter text.
Email: Click or tap here to enter text.
Phone Number: Click or tap here to enter text.
Effective Date of Contract: Click or tap here to enter text.
End Date of Contract: Click or tap here to enter text.
Value of Contract: Click or tap here to enter text.
Description of Products/Services Provided: Click or tap here to enter text.
File details come from the government source that posted it. Updated .