Exhibit A-3_Client Reference.docx
DOCX document 72 KB Posted
- Attached to
- Medical Invoicing Review Services
- Solicitation number
- RFQQ 2025 0131
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
About this file
This is a Client Reference Questionnaire (Exhibit A3) for the Washington State Department of Transportation's (WSDOT) Medical Invoicing Review Services RFQQ. The questionnaire must be completed by references for vendors bidding on the contract and submitted to WSDOT's Procurement Coordinator Chase Johnson by March 14th, 2025, at 11:59 PM Olympia time.
The questionnaire evaluates vendors on a 0-4 scale (Unsatisfactory to Exceptional) across multiple criteria including collaborative business relationships, delivery of scope, work deliverables, customer service, and flexibility in meeting changing requirements. The form includes spaces for additional comments and asks whether the reference would select the company again for future services. The evaluation is scored on a pass/fail basis rather than points.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit G_Data Sharing Agreement.docx | DOCX document | |
| Exhibit D-1_Contract Issues List.docx | DOCX document | |
| Exhibit F_Scope of Work.docx | DOCX document | |
| Exhibit A-1_Bidders Certification.docx | DOCX document | |
| Exhibit A-2_Bidders Profile.docx | DOCX document | |
| Exhibit D_Contract.docx | DOCX document | |
| RFQQ 2025 0131_Medical Invoicing Review.pdf | ||
| Exhibit C_Bid Price.docx | DOCX document | |
| RFQQ 2025 0131 - Amendment1.docx | DOCX document | |
| S2501 Market Conduct Continuum Activities.pdf | ||
| Exhibit E_DiverseBusinessInclusionPlanSubs.docx | DOCX document | |
| Exhibit H_Business Associate Agreement.docx | DOCX document | |
| Exhibit B_Performance Requirements.docx | DOCX document | |
| RFQQ 2025 0131_Questions & Answers.docx | DOCX document |
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Text version
EXHIBIT A3 – CLIENT REFERENCE QUESTIONAIRE
Instructions: Please complete the below reference form for the vendor bidding on WSDOT’s Medical Invoicing Review Services RFQQ. Once completed, please sign, date, and electronically send to WSDOT’s Procurement Coordinator on page 2 by end of business March 14th, 2025.
Solicitation RFQQ 2025 0131
BIDDER NAME:
DATE OF REFERENCE:
REFERENCE COMPANY NAME:
NAME AND TITLE OF PERSON COMPLETING FORM:
TELEPHONE NUMBER (WITH AREA CODE):
1. Please describe this company’s efforts to develop a collaborative business relationship with you, the customer:
2. Did vendor deliver all scope and address defects prior to implementation according to agreed-upon schedule and budget?
Additional comments:
Please check the value which best represents your experience with this company using the following definitions:
0 = Unsatisfactory 1=Poor 2= Average 3=Good 4=Exceptional
3. Overall satisfaction with work deliverables (on-time with deliverables)?
0 |_| 1 |_| 2 |_| 3 |_| 4 |_|
Additional comments: Easy to contact and very responsive.
4. Overall customer service: What is your opinion of this company’s level of customer service?
0 |_| 1 |_| 2 |_| 3 |_| 4 |_|
Additional comments: Very responsive to questions and resolution to problems.
5. How flexible is/was this company in meeting changing requirements?
0 |_| 1 |_| 2 |_| 3 |_| 4 |_|
Additional comments: If we need them a different day or time they are always very accommodating.
6. Based on skill and working relationship, would you select this company again to provide services? |_| Yes |_| No
Thank you for your assistance in this evaluation process.
| Signature | Date |
| Representative Name: |
Please return the reference by March 14th, 2025, no later than 11:59 pm Olympia, WA local time, to:
Procurement Coordinator
| Name: |
| Chase Johnson |
| Telephone: |
| 360-705-7741 |
| Email: |
| chase.johnson@wsdot.wa.gov |
Total points: Pass/Fail image1.png
File details come from the government source that posted it. Updated .