ESBD_541915_1784820278487_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
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- Solicitation number
- HHS0017757
- Issued by
- Hunt County, Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a dental services contract opportunity with the State of Texas serving Lubbock SSLC residents. The form establishes qualification and experience requirements that bidders must satisfy to be considered for contract award. Bidders are required to 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, service descriptions, and dates of performance. Additionally, bidders must demonstrate their operational capacity by providing information on years in business, office locations, current staffing levels (permanent full-time and part-time employees), geographic service areas, and relevant industry certifications and licenses held by staff assigned to the account.
The form requires bidders to submit a narrative description (maximum one page) of their experience and qualifications relevant to the contract requirements, along with a detailed written description of operational size and scope, including the number of employees available for customer service, order fulfillment, and product handling, as well as supervisory structure for each location. Bidders must also provide a minimum of two 24-hour emergency contacts with name, phone number, and email address. This qualification form does not address pricing, set-asides, incumbent information, or specific funding details, as it functions solely as a mechanism to establish contractor capability and past performance credentials prior to contract award consideration.
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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 .