ESBD_535906_1783624505097_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
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- Attached to
- Austin SSLC seeks Dental Anesthesia Services
- Solicitation number
- HHS0017609
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Bidder Reference and Contract Qualifications Form (Exhibit D) for a dental anesthesia services contract opportunity with the City of Austin, Texas. The form requires bidders to submit a minimum of three verifiable references for contracts of similar size and scope completed within the last five years. For each reference, bidders must provide the business name, point-of-contact information, address, phone, email, whether services were provided as prime contractor or subcontractor, and a description with dates of services performed. The form also requests additional company information including years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), geographic operational limits, and all relevant industry certifications, qualifications, formal training programs, and applicable licenses held by staff who will service the account.
The form additionally requires bidders to provide a narrative of no more than one page describing their experience and qualifications specific to the engagement, a written description of operational size and scope including available employees for customer service, order fulfillment, and product handling, as well as the number of supervisors at each location. Bidders must also designate a minimum of two 24-hour emergency contacts with name, phone number, and email address. The form is designed to comprehensively assess bidder capability, experience, staffing resources, and responsiveness to ensure qualified vendors can meet the city's dental anesthesia service requirements.
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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 .