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Workers’ Compensation TPA Program                                     RFP# HR2007-HN-01-CT
        Attachment H           ...
Workers’ Compensation TPA Program                                     RFP# HR2007-HN-01-CT
        Attachment H           ...
Workers’ Compensation TPA Program                                     RFP# HR2007-HN-01-CT
        Attachment H           ...
Workers’ Compensation TPA Program                                     RFP# HR2007-HN-01-CT
        Attachment H           ...
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Workers' Compensation TPA Program RFP# HR2007-HN-01-CT ...

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Transcript of "Workers' Compensation TPA Program RFP# HR2007-HN-01-CT ..."

  1. 1. Workers’ Compensation TPA Program RFP# HR2007-HN-01-CT Attachment H December 10, 2007 Project Example Form ATTACHMENT H PROJECT EXAMPLE FORM Proposers are to provide a list of project examples, in the format provided below, in accordance with the submittal requirements set forth in RFP Section IV, Proposal Submittal and Format Instructions. Indicate when an example is to demonstrate the proposer’s and/or a key personnel’s specialized experience/technical competence. The AOC may contact some or all of the project examples provided in order to determine the proposer and key personnel’s technical competence and specialized experience. The AOC reserves the right to contact examples other than those provided in the response and to use the information gained from them in the evaluation process. Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Page 1 of 4
  2. 2. Workers’ Compensation TPA Program RFP# HR2007-HN-01-CT Attachment H December 10, 2007 Project Example Form Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Page 2 of 4
  3. 3. Workers’ Compensation TPA Program RFP# HR2007-HN-01-CT Attachment H December 10, 2007 Project Example Form Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Page 3 of 4
  4. 4. Workers’ Compensation TPA Program RFP# HR2007-HN-01-CT Attachment H December 10, 2007 Project Example Form Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): Project Example No.: To Demonstrates Expertise of either Proposer and/or Key Personnel: Name of Client for this Example: Location of Client: Project Description: Identify Key Project Personnel for this Example (name, title, employer at time of project performance, & project responsibility – Place an asterisk (*) by the name of anyone proposed similar work for this RFP): Project’s Contract Price: Dates of Service for Example: Project References (name, organization, title, telephone, email - Please ensure information is current.): END OF FORM Page 4 of 4

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