IT Reference Questionnaire - S1662.doc
DOC document 129 KB Posted
- Solicitation number
- 40DHHS-S1724
- Issued by
- Churchill County, Nevada
About this file
This document is an IT Reference Questionnaire related to a State of Nevada Department of Administration Purchasing Division Request for Proposal (RFP) 40DHHS-S1662 for Certified Community Behavioral Healthcare Centers - Quality Incentive Payments. The RFP is seeking contractors to perform various services including planning, requirements development, business process re-engineering, system development, data modeling, presentations, system implementation and maintenance, change management, testing, and training. The completed Reference Questionnaire must be submitted by 4:30 PM PT on 09/01/2021 and should not be returned to the proposing vendor.
The Reference Questionnaire requests information on the contractor's level of involvement, whether the project was completed on time and within budget, the primary factors considered in selecting the contractor, the key personnel and any changes to them, the use of subcontractors, the timeliness and quality of deliverables, and an overall rating of the contractor's performance. The questionnaire also asks whether the reference would contract with the company again and provides an opportunity for additional comments. The RFP is for services related to Certified Community Behavioral Healthcare Centers in the jurisdiction of Carson City, Nevada.
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Other files
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|---|---|---|
| Standard Form Contract~4.docx | DOCX document | |
| Liquidated Damages.docx | DOCX document | |
| RFP 40DHHS-S1662 CCBHC.docx | DOCX document | |
| Confidentiality and Certification of Indemnification~1.pdf | ||
| DHCFP Business Associate Addendum.pdf | ||
| Project Cost Schedule~2.xlsx | XLSX spreadsheet | |
| REQUIRED DOCUMENT RFP Amendment - S1662.S1724.pdf | ||
| IT Proposed Staff Resume - S1662.doc | DOC document | |
| Quote Instructions.pdf | ||
| Surveys -Adult-Youth-Parent Child.pdf | ||
| Requirements Matrix.docx | DOCX document | |
| CCBHC Measures Technical Manual.pdf | ||
| Vendor Certifications.pdf | ||
| Sample Project Deliverable Sign Off.doc | DOC document | |
| Insurance Schedule S1662.docx | DOCX document |
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Text version
STATE OF NEVADA
DEPARTMENT OF ADMINISTRATION
Purchasing Division
515 East Musser Street, Suite 300 │ Carson City, NV 89701 Phone: 775-684-0170 │ Fax: 775-684-0188
BUSINESS REFERENCE RESPONSE TO REFERENCE QUESTIONNAIRE FOR
STATE OF NEVADA REQUEST FOR PROPOSAL (RFP) 40DHHS-S1662
Certified Community Behavioral Healthcare Centers -QIP PART A – TO BE COMPLETED BY PROPOSING VENDOR – Please type or print
Name of Company Submitting Proposal:
PART B – IF APPLICABLE, NAME OF COMPANY ACTING AS SUBCONTRACTOR
FOR VENDOR IDENTIFIED IN PART A – Please type or print
Name of Subcontractor:
PART C – BUSINESS REFERENCE INSTRUCTIONS
| 1. |
| This Reference Questionnaire is being submitted to your organization for completion as a business reference for the company listed in Part A or Part B, above. |
| 2. |
| Business reference is requested to submit the completed Reference Questionnaire via email or facsimile to: |
State of Nevada, Purchasing Division
Subject:
RFP 40DHHS-S1662
Attention:
Purchasing Division
Email:
rvradenburg@admin.nv.gov
Fax:
775-684-0188 Please reference the RFP number in the subject line of the email or on the fax.
| 3. |
| The completed Reference Questionnaire MUST be received no later than 4:30 PM PT 09/01/2021 |
| 4. |
| Do NOT return the Reference Questionnaire to the Proposer (Vendor). |
| 5. |
| In addition to the Reference Questionnaire, the State may contact references by phone for further clarification, if necessary. |
| 6. |
| Questions regarding the Reference Questionnaire or process should be directed to the individual identified on the RFP cover page. |
| 7. |
| When contacting the State, please be sure to include the RFP number listed at the top of this page. |
| 8. |
| We request all questions be answered. If an answer is not known, please answer as “U/K”. If the question is not applicable, please answer as “N/A”. |
| 9. |
| If you need additional space to answer a question or provide a comment, please attach additional pages. If attaching additional pages, please place your company/organization name on each page and reference the RFP # noted at the top of this page. |
PART D – COMPANY PROVIDING REFERENCE – Please type or print
CONFIDENTIAL INFORMATION WHEN COMPLETED
Company Providing Reference:
Contact Name:
Title:
Contact Telephone:
Contact Email Address:
PART E – QUESTIONS:
1. Did this contractor perform any of the following on your project?
| DESCRIPTION |
| YES |
| NO |
Planning and Administration?
Functional Requirements Development?
Business Process Re-engineering?
System Development?
Data Modeling?
Presentations/Legislative Testimony?
System Implementation and Maintenance?
Cultural Change Management?
Testing?
Training?
1a.
If yes, what was their level of involvement? If no, what services did the contractor perform? Please explain below.
Comments:
| 2. Was the project completed on time, within your budget, with all required major functionality delivered? |
| Yes |
No
2a.
If no, please explain below how the final results compared with the initial schedule, budget/contract value, and/or scope.
Comments:
3. What was the primary factor considered in selecting this contractor? Please explain below.
Comments:
4. Who is/was the contractor's key personnel responsible for supervising work and completing deliverables and what were their roles? Please explain below.
Comments:
| 5. Were there any changes to key personnel during the term of the contract? |
| Yes |
No
5a.
If yes, please explain below.
Comments:
| 6. Were there any subcontractors on your project? |
| Yes |
No
6a.
If yes, please identify who the subcontractors were.
Comments:
6b.
If yes, please explain below what part of the project the subcontractor worked on.
Comments:
6c.
What was the ratio of contractor staff to subcontractor staff?
6d.
Overall, how would you rate the subcontractor on a scale of 1 (poor) to 10 (excellent)?
| 7. Were contractually identified deliverables received as scheduled? |
| Yes |
No
7a.
If no, please explain below.
Comments:
7b.
What type of problems did you encounter?
Comments:
RATING SCALE:
Where a rating is requested and using the Rating Scale provided below, rate the following questions by noting the appropriate number for each item. Please provide any additional comments you feel would be helpful to the State regarding this contractor.
| Category |
| Rating |
| Poor or Inadequate Performance |
| 0 |
| Below Average Performance |
| 1 – 3 |
| Average Performance |
| 4 – 6 |
| Above Average Performance |
| 7 – 9 |
| Excellent Performance |
| 10 |
8. How would you rate this contractor on the following items using the above rating scale?
| DESCRIPTION |
| RATING |
| DESCRIPTION |
| RATING |
Project Manager
Management of Subcontractor(s)
Key Personnel
Presentations
Contractor Staff Skills
Legislative Testimony
Communication
JAD Sessions
Organization of Work
Business Process Re-engineering
Reasonableness of Cost
Evaluation of Alternatives
Timeliness
Quality Assurance
Detailed Project Plan Management
Metrics Management
Contract Amendments
Knowledge Transfer
Cooperation
Understanding of Business Needs
Responsiveness
| 9. Would you contract with this company/organization again? |
| Yes |
No
9a.
Please explain below.
Comments:
10. Please provide any additional comments you feel would be helpful to the State regarding this contractor.
Comments:
PART F – GENERAL INFORMATION:
During what time period did the vendor provide these services for your organization?
Month/Year:
| TO: |
| Month/Year: |
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