ESBD_529527_1781897588506_Exhibit D - Bidder Reference and Qualifications Form.pdf
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- Solicitation number
- HHS0017517
- Issued by
- Orange County, Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a dental services contract opportunity with the Corpus Christi State Supported Living Center in Texas. The form requires bidders to demonstrate their qualifications and experience to perform dental services for the state facility. Bidders must submit a minimum of three verifiable references for contracts of similar size and scope completed within the last five years, with each reference including the business name, point of contact information, address, phone number, email address, contractor status (prime or subcontractor), and a description of services provided with dates. The form also requires bidders to provide company information including years in business, office address, number of permanent full-time and part-time employees, total employee count, geographic operating limits, and any relevant industry certifications, qualifications, and formal training programs held by staff assigned to the account.
Additional submission requirements include a list of applicable licenses held by staff who will service the account, a narrative of no more than one page describing the bidder's experience and qualifications as it relates to Section 7.1.5, and a written description of the bidder's operational capacity including the number of employees available for customer service, order fulfillment, safe shipping and handling of products, and the number of supervisors at each location. Bidders must also provide a minimum of two 24-hour emergency contacts with name, phone number, and email address for ongoing communication and support throughout the contract term.
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Text version
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 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.
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 .