ESBD_365462_1720042468133_HHS0014941_Exhibit D Bidder Reference Form.docx
DOCX document 38 KB Posted
- Solicitation number
- HHS0014941
- Issued by
- Travis County, Austin City, Texas
About this file
This document is an Exhibit D - Bidder Reference Form and Contractor Qualifications Form for a state and local contract opportunity issued by the Texas Health and Human Services Commission (HHSC) related to monthly water treatment services and repairs of closed loop systems, cooling towers and steam boiler related to water treatment services at the Austin State Hospital. The contract requires bidders to provide a minimum of three verifiable references for similar contracts within the last three years, as well as information about the bidder's company, including number of years in business, number of employees, geographic reach, certifications, and licenses. Bidders must also provide a written description of their ability to perform the required services.
The related state and local contract opportunity is for the provision of monthly water treatment services at the Austin State Hospital located in Austin, Texas, which falls under the jurisdiction of Travis County and the City of Austin. The contract term is not specified, but may include renewal options. Pricing terms, set asides, incumbent information, and funding details are not provided in the reference form.
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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 .