ESBD_538773_1784211974004_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
PDF 104 KB Posted
- Attached to
- Wound care services for residents of RSSLC
- Solicitation number
- HHS0017728
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a wound care services contract in 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, confirmation of whether services were provided as prime contractor or subcontractor, and a description with dates of services rendered. The form also requests comprehensive company information including years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), geographic operational limits, and relevant industry certifications and licenses held by staff assigned to the account.
Additional submission requirements include a one-page narrative describing the bidder's experience and qualifications relative to the contract specifications, a written description of operational size and scope with details on employee availability for customer service and order fulfillment, safe shipping and handling capabilities, and supervisor counts by location as applicable. Bidders must provide a minimum of two 24-hour emergency contacts with names, phone numbers, and email addresses. This qualification form is dated January 21, 2026, and serves as a mandatory component of the bid response package to establish contractor capability and past performance for wound care services delivery to residents of RSSLC (likely a residential service and support living center).
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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 .