Form_5_Reference_Questionnaire.pdf
PDF 259 KB Posted
- Attached to
- Wellness Engagement Platform
- Solicitation number
- 26-8653
- Issued by
- Collier County, Florida
About this file
This is a reference questionnaire form associated with Collier County Government's Request for Proposals for a Wellness Engagement Platform, issued by the Collier County Board of County Commissioners Procurement Services Division in collaboration with the Human Resources Division. The platform will serve as a comprehensive wellness management system for the County's employee wellness program across all Constitutional agencies. The system must support two primary functional pathways: an Insurance Qualifying Process that tracks preventive screenings, laboratory work, biometrics, and wellness education offerings at both individual and group levels, and an Employee Health Reimbursement Account (HRA) program through which insured employees can earn up to $300 annually in Healthy Bucks by participating in County-sponsored wellness activities. The platform requires full customization capabilities to meet the County's specific operational and administrative needs.
The reference questionnaire form serves as a validation tool for prospective vendors to demonstrate their qualifications and experience in delivering similar wellness engagement platforms. This document type is typically used during the proposal evaluation phase to verify vendor capabilities, track record, and references from previous comparable implementations, ensuring that responding proposers possess the requisite expertise and proven performance history necessary to successfully implement and support the platform throughout its operational term.
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Text version
Version 2 9.2.25
Procurement Services Division
Form 5 Reference Questionnaire
(USE ONE FORM FOR EACH REQUIRED REFERENCE – FORM MUST BE FULLY COMPLETED AND RETURNED
WITH BID/PROPOSAL SUBMITTAL)
Solicitation:
Reference Questionnaire for:
(Name of Company Requesting Reference Information)
(Name of Individuals Requesting Reference Information)
Name:
(Evaluator completing reference questionnaire)
Company:
(Evaluator’s Company completing reference)
Email: FAX: Telephone:
Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.”
Project Description: ___________________________ Completion Date: _____________________________
Project Budget: _______________________________ Project Number of Days: _______________________
Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope).
2 Ability to maintain project schedule (complete on-time or early).
3 Quality of work.
4 Quality of consultative advice provided on the project.
5 Professionalism and ability to manage personnel.
6 Project administration (completed documents, final invoice, final product turnover;
invoices; manuals or going forward documentation, etc.)
7 Ability to verbally communicate and document information clearly and succinctly.
8 Abiltity to manage risks and unexpected project circumstances.
9 Ability to follow contract documents, policies, procedures, rules, regulations, etc.
10 Overall comfort level with hiring the company in the future (customer satisfaction).
TOTAL SCORE OF ALL ITEMS
| Text25: |
| Text26: |
| Name of Company Requesting Reference Information: |
| Text27: |
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| Project Description: |
| Completion Date: |
| Project Budget: |
| Project Number of Days: |
| Score must be completedAbility to manage the project costs minimize change orders to scope: |
| Score must be completedAbility to maintain project schedule complete ontime or early: |
| Score must be completedQuality of work: |
| Score must be completedQuality of consultative advice provided on the project: |
| Score must be completedProfessionalism and ability to manage personnel: |
| Score must be completedProject administration completed documents final invoice final product turnover invoices manuals or going forward documentation etc: |
| Score must be completedAbility to verbally communicate and document information clearly and succinctly: |
| Score must be completedAbiltity to manage risks and unexpected project circumstances: |
| Score must be completedAbility to follow contract documents policies procedures rules regulations etc: |
| Score must be completedOverall comfort level with hiring the company in the future customer satisfaction: |
| Score must be completedTOTAL SCORE OF ALL ITEMS: |
File details come from the government source that posted it. Updated .