Exhibit D Bidder Reference Qualifications Form.pdf
PDF 92 KB Posted
- Attached to
- Medicare Part D Claims Switching Services
- Solicitation number
- HHS0017787
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Bidder Reference and Contract Qualifications Form (Exhibit D) for the Medicare Part D Claims Switching Services opportunity in Texas. Bidders are required 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 business name, point-of-contact information, address, phone number, email address, clarification of whether services were performed as a prime contractor or subcontractor, and a description with dates of services provided. Additionally, bidders must provide 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.
Bidders must document all industry certifications, qualifications, and formal training programs relevant to staff servicing the account, as well as applicable licenses held by those staff members. A narrative not to exceed one page must describe the bidder's experience and qualifications as it applies to Section 7.1.5 of the requirements. Bidders must also provide a written description of operational size and scope, including the number of employees available for customer service, order fulfillment, safe shipping and product handling, and the number of supervisors per location. Finally, bidders must list a minimum of 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 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
File details come from the government source that posted it. Updated .