ESBD_360569_1716562465540_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
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- Attached to
- Richmond SSLC seeks Wound Care Specialist
- Solicitation number
- HHS0014761
- Issued by
- Fort Bend County, Texas
About this file
Exhibit D - Bidder Reference Form and Contract Qualifications Form is a document associated with a state and local contract opportunity for the Richmond State Supported Living Center (RSSLC) in Texas. The document requests bidders to provide a minimum of three verifiable references for contracts of similar size and scope of services provided within the last five years. Bidders must include details such as the business name, point of contact, address, phone, email, whether they served as a prime contractor or subcontractor, and a description of the services provided. The document also requires bidders to provide additional company information including the number of years in business, office address, number of employees, geographic limits of operations, industry certifications, licenses, and a narrative describing their experience and qualifications as they apply to the contract requirements.
The related state and local contract opportunity is for RSSLC to seek a Wound Care Specialist to provide bedside wound care for medically fragile individuals with acute and complicated wound care needs in the inpatient and outpatient setting. This contract opportunity is being solicited under Texas Government Code 2155.144 (b)(b-1), Client Services.
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Exhibit D – Bidder Reference Form and Contract Qualifications Form – 03/01/24
Exhibit D – Bidder Reference Form & Contractor Qualifications Form
Bidders must provide a minimum of three (3) verifiable references for contracts of similar size and scope of services within the last five years.
For each reference, provide the following and attach to the Response any documentation to support the information regarding current or prior contracts.
1. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Services Performed as Prime Contractor or as Subcontractor?
[Prime Contractor] or [Subcontractor]
Description and Dates of Services Provided:
2. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Services Performed as Prime Contractor or as Subcontractor?
[Prime Contractor] or [Subcontractor]
Description and Dates of Services Provided:
3. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Services Performed as Prime Contractor or as Subcontractor?
[Prime Contractor] or [Subcontractor]
Description and Dates of Services Provided:
Additional Company Information:
Number of Years in Business:
Office Address:
Current Number of Permanent, Full-Time Employees:
Current Number of Permanent, Part-Time Employees:
Current Total Number of Employees:
Geographic Limits of Operations:
List any Industry Certifications/Qualifications/Formal Training Programs that your staff (who will be servicing this account) have been certified in:
Name Certifications/Qualifications/Formal Training
List any applicable licenses currently held by staff that will service this account:
Name License Number
Bidder’s Minimum Experience and Qualifications- Section 7.1.5
Provide a narrative (maximum of one page) describing the bidder’s experience and qualifications as it applies to this Section.
Demonstration of the Ability to Perform
Provide a written description of the size and scope of all operations, including the number of Bidder’s employees available to provide customer service, order fulfillment, safe shipping and handling of product and the number of supervisors for each location, as applicable.
Exhibit D – Bidder Reference Form & Contractor Qualifications Form
File details come from the government source that posted it. Updated .