RFA REFERENCE FORM.pdf
PDF 402 KB Posted
- Attached to
- 1628-26-R-RFIN-00011-V05
- Solicitation number
- 3150006783
- Issued by
- Hinds County, Jackson City, Mississippi
About this file
This is a Reference Form for a Request for Information (RFI) issued by the Mississippi Division of Medicaid (DOM) through the Office of Procurement for a Certified Public Accountant (CPA) contract worker position within the Office of Finance. The form requests applicants to provide up to three references, with each reference entry requiring the company name, dates of service, primary contact person details (name, address, phone, cell, and email), and an optional alternate contact person with corresponding contact information. Applicants are permitted to submit additional reference forms beyond the three provided templates as needed to support their qualifications.
The reference requirements specify that references will be contacted until two references have been successfully contacted and Reference Survey Score Sheets have been completed for each. Applicants are encouraged to submit additional references beyond the minimum to ensure availability and compliance with all qualifications requirements, recognizing that not all submitted references may be contacted during the evaluation process.
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Text version
REFERENCES
Reference 1
Name of Company:
Dates of Service:
Contact Person:
Address:
City/State/ZIP:
Telephone Number:
Cell Number:
Email:
Alternate Contact Person (optional):
Alternate Contact Telephone Number:
Alternate Contact Cell Number:
Alternate Contact Email:
Reference 2 Name of Company:
Dates of Service:
Contact Person:
Address:
City/State/ZIP:
Telephone Number:
Cell Number:
Email:
Alternate Contact Person (optional):
Alternate Contact Telephone Number:
Alternate Contact Cell Number:
Alternate Contact Email:
Reference 3 Name of Company:
Dates of Service:
Contact Person:
Address:
City/State/ZIP:
Telephone Number:
Cell Number:
Email:
Alternate Contact Person (optional):
Alternate Contact Telephone Number:
Alternate Contact Cell Number:
Alternate Contact Email:
Review the reference requirements. Applicants may submit as many references as desired by submiƫng as many addiƟonal copies of this form, as deemed necessary. References will be contacted unƟl two references have been contacted and Reference Survey Score Sheets completed for each of the two references. Applicants are encouraged to submit addiƟonal references to ensure that at least two references are available, and all QR requirements are met.
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