ESBD_533661_1782915759366_Exhibit D_Bidder_Reference_Qualifications_Form.pdf
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- Solicitation number
- HHS0017560
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a Dental Services contract with the Corpus Christi State Supported Living Center in Texas. The form requires bidders to submit minimum qualifications and experience documentation to demonstrate their ability to perform the contracted services. 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, whether services were provided as a prime contractor or subcontractor, and a description and dates of services provided. Additionally, bidders must provide company information including years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), geographic limits of operations, and a list of industry certifications, qualifications, and formal training programs relevant to staff servicing the account.
The form further requires bidders to list applicable licenses held by staff who will service the account, submit a narrative (maximum one page) describing their experience and qualifications, and provide a written description of operations size and scope including the number of employees available for customer service, order fulfillment, shipping and handling, and supervisory staff by location. Bidders must also designate a minimum of two 24-hour emergency contacts with names, phone numbers, and email addresses. This qualification form serves as a critical evaluation tool to assess bidder capability and readiness to deliver dental services to the state-supported living center 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 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 .