Attachment C Reference Form.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 to procure professional temporary radiology technologists and radiology support staff for the San Francisco Health Network. The RFP, designated SFGOV-0000012046, seeks qualified firms to provide credentialed and competent staff to multiple facilities including Zuckerberg San Francisco General Hospital & Trauma Center, Laguna Honda Hospital, Jail Health Services, and SFHN Ambulatory Care sites. The proposal deadline is September 16, 2026, at 2:00 PM PT, with a questions deadline of September 8, 2026, and an estimated Q&A addendum posting on September 11, 2026. Award announcement is anticipated in October 2026, with Health Commission presentation scheduled for December 2026 and an estimated contract start date of January 1, 2027.
The Reference Form requires all bidders to provide three professional references documenting prior experience providing similar products or services. Each reference entry must include the name of the firm providing services, the client organization name, contact person and title, email and phone number, contract effective and end dates, contract value, and a description of products or services provided. This completed form must be submitted with Electronic File #2 as part of the proposal submission. All fields are mandatory for consideration.
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Text version
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 .