ESBD_548672_1786572495500_Exhibit_D_Bidder_Reference_Qualifications_Formv2.pdf
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- Attached to
- Austin SSLC seeks Dental Anesthesia Services
- Solicitation number
- HHS0017609v2
- Issued by
- Texas
About this file
This document is a Bidder Reference and Contractor Qualifications Form (Exhibit D) associated with an Austin, Texas state and local contract opportunity for Dental Anesthesia Services. 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 contracting business name, point-of-contact information, service location 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, part-time, and total employees), and geographic operational limits.
The qualifications section requires bidders to list industry certifications, qualifications, and formal training programs applicable to staff servicing the account, along with current licenses held by relevant personnel. Bidders must provide a narrative description (maximum one page) demonstrating their experience and qualifications relevant to the contract requirements, and a written description of operational size and scope including customer service capacity, order fulfillment capabilities, product shipping and handling procedures, and the number of supervisors at each location. The form mandates submission of a minimum of two 24-hour contact names, phone numbers, and email addresses for emergency communication purposes.
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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 .