ESBD_529012_1783986150723_HHS0017429 Exhibit D - Bidder Reference and Quals Form.pdf
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- Solicitation number
- HHS0017429
- Issued by
- Texas
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ESBD_529012_1783986150723_HHS0017429 Exhibit D - Bidder Reference and Quals Form
This document is a Bidder Reference and Qualifications Form for a lease agreement involving the Texas Health and Human Services Commission (HHS) and Austin State Hospital's Regional Clinical Laboratory (RCLA). The form establishes the evaluation criteria and submission requirements for bidders seeking to lease a Bio Rad D10 Hemoglobin A1C Analyzer to the state facility. Bidders must demonstrate relevant qualifications, provide references, and submit documentation of their experience with similar medical laboratory equipment leasing arrangements. The form serves as a standardized evaluation tool to assess bidder capability, financial stability, and prior performance history in providing comparable services to healthcare institutions.
The qualifications form requires bidders to provide detailed company information, including organizational structure, years in business, financial references, and technical expertise specific to hemoglobin A1C analyzer equipment and laboratory services. Bidders must list at least three professional references from comparable healthcare facilities or institutional clients that can attest to their performance, equipment reliability, and service responsiveness. The form also requires documentation of any relevant certifications, compliance credentials, and evidence of the bidder's ability to meet equipment maintenance, support, and operational standards required by the state laboratory facility.
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Exhibit D – Bidder Reference and Contract Qualifications Form – 1/21/26
Exhibit D – Bidder Reference and 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.
24-Hour Contacts – Must list a minimum of 2:
Contact 1
Name
Phone
Contact 2
Name
Phone
Exhibit D – Bidder Reference and Contractor Qualifications Form
File details come from the government source that posted it. Updated .