Exhibit-A2-ClientReference.docx
DOCX document 71 KB Posted
- Attached to
- WSDOT - WSF-Medical Surveillance
- Solicitation number
- RFP 2026-0825
- 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 reference questionnaire form for the Washington State Department of Transportation (WSDOT) WSF-Medical Surveillance Request for Proposal (RFP), Solicitation 2026-0825. The document serves as a standardized evaluation tool for prospective bidders to provide customer references demonstrating their past performance and service quality. References completing the form must provide their company name, contact information, and the date of reference, along with detailed responses regarding the vendor's ability to develop collaborative business relationships and deliver agreed-upon scope of work within established schedules and budgets.
The questionnaire employs a five-point rating scale (0 = Unsatisfactory through 4 = Exceptional) to evaluate vendor performance across multiple criteria including overall satisfaction with work deliverables and timeliness, customer service quality, flexibility in meeting changing requirements, and likelihood of future engagement. Respondents must also provide written commentary for each evaluation area. Completed reference forms must be signed, dated, and returned electronically to WSDOT's Procurement Coordinator. Questions regarding the reference process should be directed to Tariq Ohab, WSDOT's Procurement Coordinator, at 360-972-5245 or tariq.ohab@wsdot.wa.gov.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit-C-BidPrice.docx | DOCX document | |
| Exhibit-D-Contract.pdf | ||
| Exhibit-A1-BiddersCertification.docx | DOCX document | |
| Exhibit-E-SubcontractorInclusionPlan.docx | DOCX document | |
| RFP-2026-0825-MedicalSurveillance.pdf | ||
| Exhibit-D-1-ContractIssuesList.docx | DOCX document | |
| Exhibit-B-ScoredNonCostFactors.docx | DOCX document | |
| Exhibit-F-ScopeofWork.pdf |
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Text version
EXHIBIT A-2 – REFERENCE QUESTIONAIRE
Instructions: Please complete the reference form below for the vendor bidding on WSDOT’s WSF-MEDICAL SURVEILLANCE RFP. Once completed, please sign, date, and electronically send to WSDOT’s Procurement Coordinator.
Solicitation 2026-0825 - WSF-Medical Surveillance
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:
4. Overall customer service: What is your opinion of this company’s level of customer service?
0 |_| 1 |_| 2 |_| 3 |_| 4 |_|
5. How flexible is/was this company in meeting changing requirements?
0 |_| 1 |_| 2 |_| 3 |_| 4 |_|
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: |
Thank you for taking the time to fill out this information. Please contact Tariq Ohab at 360-972-5245 or tariq.ohab@wsdot.wa.gov if you have any questions.
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