Attachment C Reference Form.pdf
PDF 2 MB Posted
- Attached to
- DPH | PEI Doula Midwifery Prenatal Care Models
- Solicitation number
- SFGOV-0000012083
- Issued by
- San Francisco County, San Francisco City, California
About this file
This is an Attachment C Reference Form for the Department of Public Health (DPH) in San Francisco, California, issued in connection with Request for Proposals SFGOV-0000012083 for PEI Community-Based Doula Midwifery Prenatal Care Models. The form requires proposers to provide three professional references demonstrating prior experience delivering similar services. Each reference section requests the name of the firm that provided products or services, the client organization name, a contact person with title, email and phone number, the contract effective and end dates, the contract value, and a description of the products or services provided. The proposal submission deadline is December 7, 2026, at 2:00 PM PT, with a pre-proposal conference scheduled for November 4, 2026, and a questions deadline of November 12, 2026. Estimated short-listing notifications and interviews are scheduled for January 2027, with an estimated award announcement also in January 2027 and an estimated contract start date of July 1, 2027.
The Reference Form does not contain pricing information, set-asides, incumbent contractor details, or funding amounts. The form serves as a qualification and evaluation tool to assess proposers' experience and capability to deliver community-based doula and midwifery prenatal care services. All fields on the form are mandatory, and the completed reference form must be submitted with Electronic File #2 as part of the proposal package.
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Text version
Attachment C
Reference Form
All fields are required. This form must be completed and included with Electronic File #2.
A. 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:
End Date of Contract:
Value of Contract:
Description of Products/Services Provided:
B. Reference 2
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:
End Date of Contract:
Value of Contract:
Description of Products/Services Provided:
C. Reference 3
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:
End Date of Contract:
Value of Contract:
Description of Products/Services Provided:
| Attachment C |
| Reference Form |
| A. Reference 1 |
| B. Reference 2 |
| C. Reference 3 |
| C: Sourcing ID: Request for Proposals SFGOV-0000012083 |
| C: Solicitation Title: PEI Community-Based Doula Midwifery Prenatal Care Models |
| C: Reference 1 Contact Name and Title: |
| C: Reference 1 Email: |
| C: Reference 1 Phone Number: |
| C: Reference 1 Effective Date of Contract: |
| C: Reference 1 End Date of Contract: |
| C: Reference 1 Value of Contract: |
| C: Reference 1 Description of Products or Services Provided: |
| C: Reference 2 Organization Name: |
| C: Reference 2 Contact Name and Title: |
| C: Reference 2 Email: |
| C: Reference 2 Phone Number: |
| C: Reference 2 Effective Date of Contract: |
| C: Reference 2 End Date of Contract: |
| C: Reference 2 Value of Contract: |
| C: Reference 2 Description of Products or Services Provided: |
| C: Reference 3 Organization Name: |
| C: Reference 3 Contact Name and Title: |
| C: Reference 3 Email: |
| C: Reference 3 Phone Number: |
| C: Reference 3 Effective Date of Contract: |
| C: Reference 3 End Date of Contract: |
| C: Reference 3 Value of Contract: |
| C: Reference 3 Description of Products or Services Provided: |
| C: Reference 1 Organization Name: |
| C: Reference 1 Firm Name: |
| C: Reference 3 Firm Name: |
| C: Reference 2 Firm Name: |
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