ESBD_365708_1719588444299_HHS0014867A - Exhibit D -Bidder_Reference_.pdf
PDF 62 KB Posted
- Attached to
- Audiology Services for residents at Lufkin SSLC
- Solicitation number
- HHS0014867A
- Issued by
- Texas
About this file
This document is an Exhibit D - Bidder Reference Form and Contract Qualifications Form for the Texas state solicitation HHS0014867A to provide Audiology Services for residents at Lufkin SSLC. Bidders must provide a minimum of three verifiable references for similar contracts performed within the last five years, and include details such as business name, point-of-contact, services performed, and dates of service. The document also requires bidders to provide information about their company, including years in business, number of employees, geographic reach, industry certifications and licenses held by staff. Bidders must provide a narrative describing their experience and qualifications as they apply to the minimum requirements outlined in the solicitation.
The solicitation is seeking a contractor to provide the specified Audiology Services. No pricing terms, set asides, or funding information is provided in this document. The contract term is not explicitly stated.
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Text version
Exhibit D – Bidder Reference Form and Contract Qualifications Form – 03/01/24
HHS0014867A
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.
| HHS0014867 |
| Exhibit D – Bidder Reference Form & Contractor Qualifications Form |
File details come from the government source that posted it. Updated .