ESBD_538769_1784205478852_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
PDF 104 KB Posted
- Attached to
- Dental Anesthesia services for San Angelo SSLC
- Solicitation number
- HHS0017648
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a Dental Anesthesia services contract opportunity in San Angelo, 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, service location, phone and email details, and a description of services provided along with dates. The form also requests comprehensive company information including years in business, office address, current staffing levels (permanent full-time and part-time employees), and geographic operational limits.
The form requires bidders to document industry certifications, qualifications, and formal training programs relevant to staff assigned to the account, as well as applicable licenses held by service personnel. Bidders must provide a narrative statement not to exceed one page describing their experience and qualifications relative to the contract requirements, along with a written description of operational size and scope, including available customer service employees, order fulfillment capacity, and supervisory structure by location. Additionally, bidders must designate a minimum of two 24-hour emergency contacts with names, phone numbers, and email addresses to ensure operational continuity and responsiveness 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 .