Attachment D - Reference Check~2.docx
DOCX document 36 KB Posted
- Solicitation number
- S-13700-00012751
- Issued by
- Oregon
About this file
This is a Reference Check Form attachment for the State of Oregon's Request for Grant Application (RFGA) for Mediation & Parenting Time Support Services (RFGA S-13700-00012751). The form functions as an evaluation tool to verify applicant qualifications and experience through reference checks from entities that have previously received mediation and parenting plan support services. The document requires applicants to provide contact information for up to two reference entities, including primary and alternate contact persons with corresponding telephone, fax, and email details. For each reference, applicants must document the services provided, date ranges of service delivery, geographic locations where services were delivered, and detailed descriptions of service volume and types. The form establishes a standardized mechanism for procurement officials to validate an applicant's organizational capacity and track record in delivering family mediation and parenting support services prior to award decisions.
The Reference Check Form serves as part of the broader evaluation criteria for the RFGA, with proposals due on June 16, 2025. This attachment is one of several mandatory documents applicants must complete for submission through OregonBuys, alongside the Applicant Information and Certification form, Disclosure Exemption Affidavit, and COBID Certification and Outreach Plan. The procurement emphasizes organizational stability, service delivery capability, and experience in family mediation services, with particular attention to disadvantaged and certified business participation opportunities. By requiring documented references with specific service details and contact information, the State of Oregon establishes accountability measures to ensure selected service providers demonstrate proven experience and reliability in delivering mediation and parenting time support services to eligible populations.
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Text version
RFP [###-####-##] – [RFP title]
ATTACHMENT F - REFERENCE CHECK FORM
Mediation and Parenting Plan Support Services RFGA S-13700-00012751
ATTACHMENT D - REFERENCE CHECK FORM
| Applicant Name: | __________________________________________ |
| Contact Telephone Number: | __________________________________________ |
| Contact Email Address: | __________________________________________ |
Name of Reference Entity:
Reference Contact Person:
Telephone:
Fax:
Email:
Alternate Reference Contact Person:
Telephone:
Fax:
Email:
Services Provided:
Date range that services were provided:
Locations where services were provided:
Description of Services Provided (volume, type,) :
Name of Reference Entity:
Reference Contact Person:
Telephone:
Fax:
Email:
Alternate Reference Contact Person:
Telephone:
Fax:
Email:
Services Provided:
Date range that services were provided:
Locations where services were provided:
Description of Services Provided (volume, type,) :
| Version 1.0 - November 19, 2014 | Page 1 of 2 |
| Page 1 of 2 |
File details come from the government source that posted it. Updated .