ESBD_371855_1723479168793_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
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- Attached to
- RSSLC seeks Imaging and Diagnostic services
- Solicitation number
- HHS0014709
- Issued by
- Fort Bend County, Texas
About this file
The document is an Exhibit D - Bidder Reference Form and Contract Qualifications Form associated with a Request for Bids (RFB) issued by the Richmond State Supported Living Center (RSSLC) in Texas for Imaging and Diagnostic Services. The form requires bidders to provide a minimum of three verifiable references for contracts of similar size and scope within the last five years, including details on the services performed, dates, and whether the bidder acted as a prime contractor or subcontractor. The form also requests information on the bidder's company, including years in business, number of employees, geographic limits of operations, and any relevant certifications, qualifications, licenses, and formal training programs. Bidders are asked to provide a narrative describing their experience and qualifications as they apply to the RFB's requirements.
The pricing terms, set asides, funding requirements, and other salient information are not provided in this document. However, the RFB is seeking Imaging and Diagnostic Services for residents of the Richmond State Supported Living Center in Texas under the Texas Government Code 2155.144 (b) (b-1), Client Services.
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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 .