ESBD_542454_1784920368410_Exhibit_D_Bidder_Reference_Qualifications_Form.docx
DOCX document 31 KB Posted
- Attached to
- As Needed Tire Repair, Austin State Hospital
- Solicitation number
- HHS0017687
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for an as-needed tire repair contract with Austin State Hospital in Texas. Bidders must submit a minimum of three verifiable references for contracts of similar size and scope completed within the last five years. For each reference, bidders are required to provide the business name, point-of-contact information including name and title, complete address, phone number, email address, identification of whether services were performed as a prime contractor or subcontractor, and a detailed description with dates of services provided. The form also requires submission of supporting documentation to substantiate information regarding current or prior contracts.
The form requires bidders to provide comprehensive company information including years in business, office address, current number of permanent full-time and part-time employees, total employee count, and geographic limits of operations. Bidders must list all industry certifications, qualifications, and formal training programs relevant to staff servicing the account, along with applicable licenses held by service personnel. Additionally, bidders must submit a narrative of no more than one page describing their experience and qualifications as applied to Section 7.1.5, provide a written description of operations size and scope including available customer service employees and supervisors at each location, and designate a minimum of two 24-hour emergency contacts with names, phone numbers, and email addresses.
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Text version
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 Email Contact 2 Name Phone Email
Exhibit D – Bidder Reference and Contract Qualifications Form – 1/21/26
File details come from the government source that posted it. Updated .