Reference Questionnaire - 01-24-20.doc

109 KB Posted

Attached to
Workers' Compensation Uninsured Claims Administration
Solicitation number
74BAI-S1476
Issued by
Churchill County, Nevada

About this file

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This document is a Reference Questionnaire for State of Nevada Request for Proposal (RFP) 74BAI-S1476 for Workers' Compensation Uninsured Claims Administrator. The RFP is being issued by the State of Nevada Department of Administration Purchasing Division for a contract to provide services in Clark County and the City of Las Vegas. The questionnaire is intended to gather information about the performance and qualifications of a proposing vendor or subcontractor from a business reference. The questionnaire covers areas such as the vendor's knowledge and expertise, flexibility, quality of work, customer service, and ability to resolve problems and meet business requirements. The reference is asked to provide ratings and comments on these aspects of the vendor's services.

The related state and local contract opportunity is for Workers' Compensation Uninsured Claims Administration services in Clark County and the City of Las Vegas. The reference questionnaire does not provide details on pricing, set asides, incumbents, funding requirements, or other commercial terms. The focus is on evaluating the vendor's past performance and qualifications.

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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’S RESPONSE TO REFERENCE QUESTIONNAIRE FOR

STATE OF NEVADA REQUEST FOR PROPOSAL (RFP) 74BAI-S1476

WORKERS’ COMPENSATION UNINSURED CLAIMS ADMINISTRATOR

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 74BAI-S1476

Attention:

Purchasing Division

Email:

nfeser@admin.nv.gov

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 March 15, 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:

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

PART E – QUESTIONS:

1. In what capacity have you worked with this vendor in the past?

2. Rate the firm’s knowledge and expertise.
RATING:

Comments:

3. Rate the vendor’s flexibility relative to changes in the project scope and timelines.
RATING:

Comments:

4. Rate your level of satisfaction with soft and/or hard copy materials produced by the vendor.
RATING:

Comments:

5. Rate the dynamics/interaction between the vendor and your staff.
RATING:

Comments:

6. Rate your satisfaction with the products developed by the vendor.
RATING:

Comments:

7. Rate how well the agreed upon, planned schedule was consistently met and deliverables provided on time. (This pertains to delays under the control of the vendor).
RATING:

Comments:

8. Rate the overall customer service and timeliness in responding to customer service inquiries, issues and resolutions.
RATING:

Comments:

9. Rate the knowledge of the vendor’s assigned staff and their ability to accomplish duties as contracted.
RATING:

Comments:

10. Rate the accuracy and timeliness of the vendor’s billing and/or invoices.
RATING:

Comments:

11. Rate the vendor’s ability to quickly and thoroughly resolve a problem related to the services provided.
RATING:

Comments:

12. Rate the vendor’s flexibility in meeting business requirements.
RATING:

Comments:

13. Rate the likelihood of your company/organization recommending this vendor to others in the future.
RATING:

Comments:

14. With which aspect(s) of this vendor’s services are you most satisfied?
RATING:

Comments:

15. With which aspect(s) of this vendor’s services are you least satisfied?
RATING:

Comments:

16. Would you recommend this vendor to your organization again?
RATING:

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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