ESBD_547061_1786113320474_Exhibit_D_Bidder_Reference_Qualifications_Form.docx
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- Attached to
- Immunization Services for DSHS Lab employees
- Solicitation number
- HHS0017624
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a state and local contract opportunity. The form requires bidders to submit a minimum of three verifiable references for contracts of similar size and scope performed within the last five years. For each reference, bidders must provide the contracting business name, point-of-contact information, service location, contact details, whether services were provided as a prime contractor or subcontractor, and a description with dates of services rendered. Additionally, bidders must supply company information including years in business, office address, current permanent full-time and part-time employee counts, total employee numbers, and geographic operational limits.
The form also requires bidders to list industry certifications, qualifications, and formal training programs relevant to staff servicing the account, as well as applicable licenses held by service staff. Bidders must provide a one-page narrative describing their experience and qualifications as specified in Section 7.1.5, along with a written description of operational size and scope including available customer service employees, order fulfillment capacity, and safe shipping and handling procedures. The form mandates identification of supervisory staff at each location. Finally, bidders must 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 .