ESBD_429491_1752162781596_EXHIBI~4.PDF
PDF 121 KB Posted
- Solicitation number
- HHS0016159
- Issued by
- Van Zandt County, Texas
About this file
This document is a Bidder Reference and Contractor Qualifications Form for Solicitation HHS0016159, issued by a Texas state agency (likely Health and Human Services). The form requires bidders to provide a minimum of three verifiable references for contracts of similar size and scope within the last three years, with detailed information about each reference including business name, point of contact, address, services performed, and whether the work was as a prime or subcontractor.
The form also collects comprehensive company information, including years in business, employee counts, geographic operational limits, industry certifications, and staff licenses. Bidders must demonstrate their experience and qualifications relevant to the Scope of Work, providing a written description of their operations, available employees, and supervisory structure. The document appears to be a standard qualification form designed to assess a bidder's capabilities, experience, and readiness to perform services for the solicitation, with space for detailed explanations of the company's background and expertise.
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Text version
Solicitation HHS0016159
Exhibit D – Bidder Reference and Contractor Qualifications Form
Name of Business:____________________________________________________
Texas Vendor ID No. or Federal 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 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:
3. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Solicitation HHS0016159
Exhibit D – Bidder Reference and Contractor Qualifications Form
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:
List any 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 Scope of Work, and the number of supervisors for each location, as applicable. Additional pages may be added as needed.
| Solicitation HHS0016159 |
| Exhibit D – Bidder Reference and Contractor Qualifications Form |
File details come from the government source that posted it. Updated .