ESBD_366872_1720524455131_EXHIBI~1.PDF

HHS0014777

Exhibit D – Bidder Reference Form & Contractor Qualifications Form

Name of Business:_______________________________________

Texas Vendor ID No. :____________________________________

References:

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: Provide a description of the bidder’s experience and qualifications as it applies to the Scope of Work. Additional pages may be added as needed.

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 the services in the SOW, and the number of supervisors for each location, as applicable. Additional pages may be added as needed.