ESBD_364036_1718997416975_HHS0014816_Exhibit D Bidder Reference Form.docx
DOCX document 38 KB Posted
- Solicitation number
- HHS0014816
- Issued by
- Johnson County, Texas
About this file
The document is the Exhibit D - Bidder Reference Form and Contractor Qualifications Form for a state and local contract opportunity in Texas. This form requires bidders to provide a minimum of three verifiable references for similar contracts within the last three years, as well as additional company information such as number of years in business, office location, number of employees, and any relevant certifications or licenses. The related state and local contract opportunity is for the addition of an office location to the Region 05 Beaumont Warehouse, which is being sought by the Texas Health and Human Services Commission (HHSC) PCS. The contract is open to all interested bidders, and no additional details on pricing, set asides, or funding sources are provided in the document.
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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 three (3) 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.
24-Hour Contacts – Must list a minimum of 2:
Contact 1 Name Phone Email Contact 2 Name Phone Email
Exhibit D – Bidder Reference Form and Contract Qualifications Form – 03/01/24
File details come from the government source that posted it. Updated .