RELEVANT_EXPERIENCE_FORM.pdf

267 KB Posted

Attached to
Purchase of Antibiotics
Solicitation number
2026-Informal-0210
Issued by
Los Angeles County, California

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Relevant Experience Form Summary

This is a Relevant Experience Form template created for competitive bidding purposes, involving the City of Pasadena Public Health Department (PPHD) in California. The form requires bidders to document five completed projects of similar scope and size to the proposed contract. For each project, bidders must provide comprehensive information including the project name, address/location, start and completion dates, detailed contract descriptions across eight separate description fields, and complete contract owner information (owner name, contact person, title, address, phone number, and email). The form is designed to allow PPHD to evaluate contractor qualifications and relevant experience before awarding a contract for antibiotic procurement. Bidders must submit the completed five-page form as part of their bid package.

The contract opportunity involves a one-time purchase of antibiotics (specifically Doxycycline and Ciprofloxacin) from a qualified vendor to establish a strategic stockpile for the City of Pasadena. The stockpile is intended for rapid deployment to city staff and their dependents following potential exposure to Category A biological agents such as anthrax, plague, or tularemia, with the goal of maintaining critical services during public health emergencies. The vendor must demonstrate competitive pricing and the ability to deliver the requested antibiotics within the city's fiscal year ending June 30, 2027. PPHD emphasizes seeking vendors committed to quality products and timely delivery to support the city's biodefense and emergency preparedness objectives.

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RELEVANT EXPERIENCE FORM

Please complete the next five (5) pages to demonstrate experience with projects of similar scope and size to that which is to be performed. This completed form will be submitted with bid.

Project No. 1

Project Name ____________________________________________

Project Address/Location ___________________________________________________________

Date of Start/Completion of Project ___________________________

Contract Description

Contract Owner Information:

Owner __________________________________________________________

Name of Contact __________________________________________________

Title ____________________________________________________________

Address _________________________________________________________

Phone Number __________________________ Email ____________________

Project No. 2

Project Name ____________________________________________

Project Address/ Location_________________________________________________________

Date of Start/Completion of Project ___________________________

Contract Description

Contract Owner Information:

Owner __________________________________________________________

Name of Contact __________________________________________________

Title ____________________________________________________________

Project No. 3

Project Name ____________________________________________

Project Address/ Location___________________________________________________________

Date of Start/Completion of Project ___________________________

Contract Description

Contract Owner Information:

Owner __________________________________________________________

Name of Contact __________________________________________________

Title ____________________________________________________________

Project No. 4

Project Name _____________________________________________________________

Project Address/ Location________________________________________________________

Date of Start/Completion of Project ___________________________

Contract Description

Contract Owner Information:

Owner __________________________________________________________ Name of Contact __________________________________________________ Title ____________________________________________________________

Project No. 5

Project Name ____________________________________________________________________

Project Address/ Locaton___________________________________________________________

Date of Start/Completion of Project ___________________________

Contract Description

Contract Owner Information:

Owner __________________________________________________________ Name of Contact __________________________________________________ Title ____________________________________________________________

ADDENDUM NO. 3
Work Experience.pdf
2021-08-13 100%CD Allendale Branch Library Seismic Retrofit Phase 1.pdf
Sheets
S0.0 - SHEET INDEX, ABBREVIATIONS AND SYMBOLS
S0.1 - GENERAL NOTES
S1.0 - ROOF FRAMING PLAN
S2.0 - EXTERIOR ELEVATION
S3.0 - MISC DETAILS
S3.1 - MISC DETAILS
S4.0 - TYPICAL WOOD DETAILS
Project Name:
Project AddressLocation:
Date of StartCompletion of Project:
Contract Description 1:
Contract Description 2:
Contract Description 3:
Contract Description 4:
Contract Description 5:
Contract Description 6:
Contract Description 7:
Contract Description 8:
Owner:
Name of Contact:
Title:
Address:
Phone Number:
Email:
Project Name_2:
Project Address Location:
Date of StartCompletion of Project_2:
Contract Description 1_2:
Contract Description 2_2:
Contract Description 3_2:
Contract Description 4_2:
Contract Description 5_2:
Contract Description 6_2:
Contract Description 7_2:
Contract Description 8_2:
Owner_2:
Name of Contact_2:
Title_2:
Address_2:
Phone Number_2:
Email_2:
Project Name_3:
Project Address Location_2:
Date of StartCompletion of Project_3:
Contract Description 1_3:
Contract Description 2_3:
Contract Description 3_3:
Contract Description 4_3:
Contract Description 5_3:
Contract Description 6_3:
Contract Description 7_3:
Contract Description 8_3:
Owner_3:
Name of Contact_3:
Title_3:
Address_3:
Phone Number_3:
Email_3:
Project Name_4:
Project Address Location_3:
Date of StartCompletion of Project_4:
Contract Description 1_4:
Contract Description 2_4:
Contract Description 3_4:
Contract Description 4_4:
Contract Description 5_4:
Contract Description 6_4:
Contract Description 7_4:
Contract Description 8_4:
Owner_4:
Name of Contact_4:
Title_4:
Address_4:
Phone Number_4:
Email_4:
Project Name_5:
Project Address Locaton:
Date of StartCompletion of Project_5:
Contract Description 1_5:
Contract Description 2_5:
Contract Description 3_5:
Contract Description 4_5:
Contract Description 5_5:
Contract Description 6_5:
Contract Description 7_5:
Contract Description 8_5:
Owner_5:
Name of Contact_5:
Title_5:
Address_5:
Phone Number_5:
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