ESBD_365246_1719441516063_HHS0014837_Exhibit D Bidder Reference Form.docx
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- Solicitation number
- HHS0014837
- Issued by
- Travis County, Austin City, Texas
About this file
The document is an Exhibit D - Bidder Reference Form and Contractor Qualifications Form for a state and local contract opportunity in Texas. The contract is for general construction services at the Austin State Hospital, which is being sought by the Texas Health and Human Services Commission (HHSC) PCS. Bidders must provide a minimum of three verifiable references for similar contracts completed within the last three years, and include details such as the company name, point of contact, services performed, and dates. Additional company information required includes years in business, office address, number of employees, geographic limits, and relevant staff certifications and licenses.
The overall contract opportunity covers multiple jurisdictions in the Austin, Texas area, including Travis County and the City of Austin. Bidders must demonstrate their ability to perform the required services, including providing 24-hour contacts. The contract term and any renewal options are not specified in the provided documentation.
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Text version
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 .