ESBD_371855_1723479168793_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
PDF 71 KB Posted
- Attached to
- RSSLC seeks Imaging and Diagnostic services
- Solicitation number
- HHS0014709
- Issued by
- Fort Bend County, Texas
About this file
This document is the Exhibit D - Bidder Reference Form and Contract Qualifications Form for a contract opportunity issued by the Richmond State Supported Living Center (RSSLC) in Texas. The contract is for Imaging and Diagnostic services for RSSLC residents, under the Texas Government Code 2155.144 (b) (b-1), Client Services. Bidders must provide a minimum of three references for similar contracts within the last five years, including details on the services performed, contract dates, and whether the bidder was the prime contractor or subcontractor. The form also requires bidders to provide information on their company, including years in business, number of employees, geographic scope, and any relevant certifications, qualifications, or licenses held by staff. Bidders must also provide a narrative description of their experience and qualifications as they apply to the minimum requirements outlined in Section 7.1.5 of the contract, as well as a written description of their operational capabilities to provide the required services.
The contract opportunity is limited to the state of Texas, specifically in Fort Bend County. No additional details are provided on pricing terms, set-asides, incumbent contractors, funding sources, or contract amounts.
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Text version
Exhibit D – Bidder Reference Form and Contract Qualifications Form – 03/01/24
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 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.
Exhibit D – Bidder Reference Form & Contractor Qualifications Form
File details come from the government source that posted it. Updated .