ESBD_361728_1717682345997_Exhibit D - Bidder Reference Form.pdf
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- Solicitation number
- HHS0014684A
- Issued by
- Travis County, Texas
About this file
This document is the Exhibit D - Bidder Reference Form and Contract Qualifications Form for a state and local contract opportunity in Texas. The contract is for dental services at the San Angelo State Supported Living Center, with the jurisdictions of Tom Green County and the city of San Marcos. Bidders must provide a minimum of three verifiable references for similar contracts within the last five years, including the business name, point-of-contact information, description of services provided, and whether the bidder was a prime contractor or subcontractor. Bidders must also provide information on their company, including years in business, number of employees, geographic limits of operations, industry certifications, and applicable licenses. Additionally, bidders must provide a narrative describing their experience and qualifications, as well as a written description of their operations and ability to perform the required services.
The contract opportunity is for the Texas Health and Human Services Commission (HHSC) to establish contract(s) for dental services at the San Angelo State Supported Living Center. No additional details are provided regarding pricing, set asides, incumbents, funding requirements, or other salient information.
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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 (5) 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.
File details come from the government source that posted it. Updated .