ESBD_548448_1786539122050_Exhibit_D_Bidder_Reference_Qualifications_Form.pdf
PDF 92 KB Posted
- Attached to
- Dental Surgery Services for AbSSLC
- Solicitation number
- HHS0017574v2
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a Dental Surgery Services contract opportunity in Texas. The form requires bidders to provide a minimum of three verifiable references for contracts of similar size and scope completed within the last five years. For each reference, bidders must supply the contracting business name, point-of-contact information, service location details, phone and email contact information, whether services were provided as a prime contractor or subcontractor, and a description of services with associated 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.
Additional requirements include documentation of industry certifications, qualifications, and formal training programs applicable to staff servicing the account, as well as current licenses held by personnel. Bidders must provide a narrative description (maximum one page) demonstrating experience and qualifications relevant to the contract requirements. The form requires a detailed written description of operational size and scope, including the number of employees available for customer service, order fulfillment, safe shipping and handling of products, and supervisory personnel for each location. Bidders must also provide a minimum of two 24-hour emergency contacts with names, phone numbers, and email addresses to ensure continuity of service delivery.
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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
File details come from the government source that posted it. Updated .