ESBD_481083_1767887509965_Exhibit D Bidder Reference & Contractor Qualifications.pdf
PDF 148 KB Posted
- Attached to
- Dental Anesthesia Services at Austin SSLC
- Solicitation number
- HHS0016850
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for Solicitation HHS0016850 issued by the State of Texas for Dental Anesthesia Services at Austin SSLC. The form requires bidders to demonstrate their qualifications and experience in providing services comparable to those outlined in the scope of work. Bidders must provide a minimum of three verifiable references for contracts of similar size and scope completed within the last five years, with each reference including business name, point of contact information, address, phone, email, service descriptions, dates of service, and designation of whether services were provided as a prime contractor or subcontractor. The form also requests comprehensive company information including years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), and any geographic operational limitations.
Additionally, bidders must document all industry certifications, qualifications, and formal training programs relevant to staff who will service the account, as well as applicable licenses held by service personnel. Bidders are required to provide detailed descriptions of their experience and qualifications as applied to the scope of work, the size and scope of operations, the number of employees available to perform the services, and the number of supervisors for each location as applicable. The form allows for additional pages to be submitted as needed to fully demonstrate bidder capability and capacity to perform the requested services.
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Text version
Solicitation HHS0016850 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 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:
3. Business Name:
Point-of-Contact Name and Title:
Address (City, State, Zip):
Phone:
Email address:
Solicitation HHS0016850 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 HHS0016850 |
| Exhibit D – Bidder Reference and Contractor Qualifications Form |
File details come from the government source that posted it. Updated .