ESBD_556284_1788452915441_Exhibit_D_Bidder_Reference_Qualifications_Form.docx
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- Solicitation number
- HHS0017629V2
- Issued by
- Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form (Exhibit D) for a Part Time Forensic Psychology Services contract with El Paso Psychiatric Center in Texas. The form requires bidders to submit a minimum of three verifiable references for contracts of similar size and scope completed within the last two years. For each reference, bidders must provide the business name, point-of-contact information, address, phone, email, whether services were performed as prime contractor or subcontractor, and a detailed description with dates of services provided. Additionally, bidders must complete a company information section documenting years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), and geographic limits of operations.
Bidders are required to list all industry certifications, qualifications, and formal training programs relevant to staff servicing the account, along with applicable licenses held by those staff members. The form requests a maximum one-page narrative addressing bidder experience and qualifications per Section 7.1.5, and a written description of operational size and scope including available customer service employees, order fulfillment capacity, safe shipping and handling procedures, and supervisor counts by location as applicable. Bidders must also provide 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 two (2) 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 .