ESBD_438346_1753215047657_HHS0016302_Exhibit D - Bidder Reference and Quals Form.v2.pdf
PDF 162 KB Posted
- Solicitation number
- HHS0016302.v2
- Issued by
- Nueces County, Texas
About this file
Exhibit D is a Bidder Reference Form and Contract Qualifications Form for Solicitation HHS0016302, issued by the Texas Health and Human Services Commission (HHSC) for Dental Services at the Corpus Christi State Supported Living Center (CCSSLC). The document requires bidders to provide comprehensive information about their company's qualifications, including at least three verifiable references for similar contracts completed within the last five years, details about the company's operational structure, and a narrative describing the bidder's experience and ability to perform dental services for individuals with intellectual disabilities. Bidders must document their operational capabilities, including the number of full-time and part-time employees, geographic operational limits, industry certifications, and staff licenses.
The form is designed to evaluate potential contractors' qualifications for providing dental oral surgery services, with a focus on comprehensive documentation of the bidder's experience, capabilities, and professional credentials. Bidders are required to provide a detailed description of their operations, including the number of employees available for customer service, order fulfillment, safe shipping and handling, and supervisor roles. The document emphasizes the need for contractors to demonstrate expertise in serving individuals with intellectual disabilities, with a particular focus on professional licensing, relevant experience, and the ability to provide a wide range of dental and oral surgical services. While specific pricing details are not included in this exhibit, the form is part of a broader solicitation process aimed at selecting the most qualified and competent dental services provider for the CCSSLC.
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Exhibit D – Bidder Reference Form and Contract Qualifications Form – 03/01/24
Solicitation HHS0016302 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 7.1.5
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.
File details come from the government source that posted it. Updated .