ESBD_490709_1771439535653_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf

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Attached to
Dental Services, Austin State Supported Living Center
Solicitation number
HHS0016250V3
Issued by
Travis County, Austin City, Texas

About this file

This is a Bidder Reference Form and Contractor Qualifications Form (Exhibit D) for a state and local contract opportunity, dated March 1, 2024. The document outlines mandatory requirements for bidders to demonstrate their qualifications and experience relevant to the contract opportunity. Bidders must provide a minimum of three verifiable references for contracts of similar size and scope completed within the last three years, with each reference including business name, point of contact information, service descriptions, dates of performance, and clarification of whether services were provided as prime contractor or subcontractor. Additionally, bidders must provide company background information including years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), and geographic operational limits.

Bidders are required to demonstrate relevant industry certifications, qualifications, formal training programs, and applicable licenses held by staff assigned to service the account. The form requires a narrative statement not to exceed one page describing the bidder's experience and qualifications as applicable to the contract specifications, along with a detailed written description of operational size and scope, including the number of employees available for customer service, order fulfillment, safe shipping and product handling, and the number of supervisors for each location as applicable. Supporting documentation must be attached to substantiate all information provided regarding current or prior contracts.

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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 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 & Contractor Qualifications Form

File details come from the government source that posted it. Updated .