ESBD_363901_1718895535371_Exhibit D - Bidder Reference Form.pdf
PDF 740 KB Posted
- Attached to
- Pharmacy Services, Waco Center for Youth
- Solicitation number
- HHS0014812
- Issued by
- Henderson County, Wichita Falls City, Texas
About this file
This document is the Bidder Reference Form and Contract Qualifications Form for a state and local contract opportunity in Texas. It requires bidders to provide at least three verifiable references for similar contracts performed within the last five years, including details on the services performed, contract term, and company information such as years in business, number of employees, and industry certifications. The contract opportunity is for pharmacy services at the Waco Center for Youth, solicited by the Texas Health and Human Services Commission under Texas Government Code 2155.144(b), (b-1)(2). No additional details on the scope, term, or quantities of the contract are provided.
The form also requires bidders to describe their experience and qualifications as they relate to the minimum requirements stated in the solicitation, as well as provide a written description of their overall operations and resources available to service the contract, such as customer service, order fulfillment, and shipping capabilities.
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Text version
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 .