ESBD_394345_1738959135470_HHS0015672 - Exhibit D Bidder Reference Qualifications Form.docx
DOCX document 34 KB Posted
- Attached to
- Repairs Bladder Scanners for Lufkin SSLC
- Solicitation number
- HHS0015672
- Issued by
- Angelina County, Texas
About this file
This is a bidder reference form and contractor qualifications form (Exhibit D) for Texas Health and Human Services Commission (HHSC) solicitation HHS0015672 for biomedical maintenance services. The form requires bidders to provide a minimum of three verifiable references for similar contracts completed within the past three years, with each reference needing to include business name, point of contact details, and description of services provided. Bidders must indicate whether they served as prime contractor or subcontractor for each reference.
The form also requires detailed company information including years in business, office address, current employee counts (full-time and part-time), geographic operation limits, and staff certifications/qualifications. Bidders must provide a one-page narrative describing their experience and qualifications, along with a written description of their operational capabilities including customer service, order fulfillment, shipping/handling, and supervision structure. The document is dated March 1, 2024, though the actual solicitation indicates key dates including question submissions due February 13, 2025, and bid responses due February 24, 2025.
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Text version
HHS0015672
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 three (3) 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 and Contract Qualifications Form – 03/01/24
File details come from the government source that posted it. Updated .