Exhibit_D_Bidder_Reference_Qualifications_Form.docx
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- Attached to
- Lead Sample Analysis Services for the Department of State Health Services Laboratory located in Austin, TX.
- Solicitation number
- HHS0017054
- Issued by
- Travis County, Texas
About this file
This is a Bidder Reference and Contractor Qualifications Form for a Texas state and local contract opportunity. The form requires bidders to submit a minimum of three verifiable references for contracts of similar size and scope completed within the last three years. For each reference, bidders must provide the business name, point-of-contact information including name, title, address, phone, and email, specify whether services were performed as a prime contractor or subcontractor, and include a description and dates of services provided. Additionally, bidders must supply general company information including years in business, office address, current staffing levels (permanent full-time, permanent part-time, and total employees), and geographic limits of operations.
The form requires bidders to document all industry certifications, qualifications, and formal training programs held by staff who will service the account, as well as applicable licenses. Bidders must provide a narrative statement not exceeding one page describing their experience and qualifications relevant to the contract requirements, along with a written description of their operational size and scope, including the number of employees available for customer service, order fulfillment, and product shipping and handling, plus the number of supervisors per location as applicable. The form also mandates the submission of at least two 24-hour emergency contacts with name, phone number, and email address for each contact.
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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 three (3) 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 .