ESBD_381064_1730829029607_Exhibit D - Bidder Reference.pdf
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- Solicitation number
- HHS0014976
- Issued by
- Travis County, Texas
About this file
This is a Bidder Reference Form and Contract Qualifications Form (Exhibit D) issued by the Texas Health and Human Services Commission (HHSC) and Department of State Health Services (DSHS) for biomedical repair services for durable medical equipment. The form requires bidders to provide a minimum of three verifiable references for contracts of similar size and scope performed within the last five years, with detailed contact information and descriptions of services provided for each reference.
The form includes sections for additional company information such as years in business, office address, current staffing levels (full-time and part-time employees), geographic limits of operations, and industry certifications/qualifications of staff who will service the account. Bidders must also provide a narrative describing their experience and qualifications (limited to one page) and demonstrate their ability to perform by describing their operational capacity, including customer service, order fulfillment, shipping capabilities, and supervisory structure. The form includes tables for listing staff certifications, qualifications, formal training, and applicable licenses.
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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 (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 7.1.6
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.
File details come from the government source that posted it. Updated .