Attachment C Reference Form_1.pdf
PDF 81 KB Posted
- Attached to
- DPH | HIV Prevention CBA Program Admin Services
- Solicitation number
- SFGOV-0000011811
- Issued by
- San Francisco County, San Francisco City, California
About this file
This is a Reference Form document from the San Francisco Department of Public Health (DPH) for a Request for Proposals (RFP SFGOV-0000011811) concerning HIV Prevention Capacity Building Assistance Program Administration Services. Proposers must complete and submit this attachment with their proposals to demonstrate relevant experience. The form requests information for up to six references, with each reference requiring details about the firm that provided products or services (whether as a prime contractor or subcontractor), the organization name, contact person and title, email, phone number, effective contract dates, contract value, and a description of the products or services provided. The RFP was published on July 10, 2026, with a pre-proposal conference scheduled for July 23, 2026, a deadline for questions on July 30, 2026, and a proposal submission deadline of August 13, 2026 at 2:00 PM Pacific Time. The estimated award announcement is scheduled for September 2026, with a Health Commission presentation potentially occurring in March 2027 and an estimated program start date of April 1, 2027.
The program is funded by the Centers for Disease Control and Prevention (CDC) under Funding Opportunity Announcement PS 24-0020, component D, and seeks qualified firms to provide program administration and staffing services for the getSFcba capacity building assistance initiative. The reference form itself does not specify pricing terms, set-asides, or funding amounts, as it functions solely as an evaluation tool for assessing proposer qualifications and past performance on similar projects through documented client references.
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Text version
ATTACHMENT “C”
REFERENCE FORM
REQUEST FOR PROPOSALS SFGOV-0000011811
HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION CAPACITY BUILDING
ASSISTANCE PROGRAM ADMINISTRATION SERVICES
*THIS FORM MUST BE COMPLETED AND SUBMITTED WITH YOUR PROPOSAL*
Reference 1 Name of firm that provided products/services to reference (Prime or Subcontractor’s Name):
Organization Name: Contact Name and Title:
Email: Phone Number:
Effective Date of Contract: Value of Contract:
Description of Products/Services Provided:
Reference 2 Name of firm that provided products/services
Organization Name: Contact and Title:
Description of products/services provided:
Reference 3 Name of firm that provided products/services
Organization Name: Contact and Title:
Description of products/services provided:
| Name of firm that provided productsservices to reference Prime or Subcontractors Name: |
| Organization Name: |
| Contact Name and Title: |
| Email: |
| Phone Number: |
| Effective Date of Contract: |
| Value of Contract: |
| Description of ProductsServices Provided: |
| Name of firm that provided productsservices to reference Prime or Subcontractors Name_2: |
| Organization Name_2: |
| Contact and Title: |
| Email_2: |
| Phone Number_2: |
| Effective Date of Contract_2: |
| Value of Contract_2: |
| Description of productsservices provided: |
| Name of firm that provided productsservices to reference Prime or Subcontractors Name_3: |
| Organization Name_3: |
| Contact and Title_2: |
| Email_3: |
| Phone Number_3: |
| Effective Date of Contract_3: |
| Value of Contract_3: |
| Description of productsservices provided_2: |
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