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Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 1 of 13 Legal Business Name of Company Bidding
Bidder’s Federal Tax Identification Number
INSTRUCTIONS: For each Key Personnel Title/Candidate proposed, 1) please list all organizations where the candidate has demonstrated the required experience, including a detailed description of those services provided, per RFP Section 5.3 Key Personnel; 2) provide three (3) references for the Candidate proposed. References should have received similar services as described in this RFP. Each organization listed above must be included in your reference documentation. NYSPro reserves the right to contact any organization to verify experience and quality of services performed.
Section 1. Enterprise Architect Candidate
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
1.1 Eight (8) years of experience with large scale transformation efforts and Enterprise Architecture to support these transformations
Organization Detailed Description of Services/Experience Start Date End Date No. Years
1.2 Demonstrated experience with Enterprise Architecture standards such as TOGAF®, and EA methodologies and tools
Organization Detailed Description of Services/Experience Start Date End Date No. Years
1.3 Demonstrated experience in using the National Human Services Interoperability Architecture (NHSIA) and Medicaid Information Technology Architecture (MITA)
Organization Detailed Description of Services/Experience Start Date End Date No. Years
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 2 of 13 1.4 References
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 3 of 13
Section 2. Functional Lead Candidate
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
2.1 Ten (10) years of experience in Business Process Redesign Organization Detailed Description of Services/Experience Start Date End Date No. Years
2.2 Ten (10) years of experience with Requirements ManagementOrganization Detailed Description of Services/Experience Start Date End Date No. Years
2.3 Demonstrated experience working with architecture-based approach to requirements analysisOrganization Detailed Description of Services/Experience Start Date End Date No. Years
2.4 Demonstrated experience using Business Process Management and Requirements Management tools Organization Detailed Description of Services/Experience Start Date End Date No. Years
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 4 of 13 2.5 References
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
2.6
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 5 of 13
Section 3. Program Management Lead Candidate
Candidate Name
PMP Certification Date
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
3.1 Five (5) years pf experience in a Program Management Office (PMO) role on at least 1 large scale enterprise level initiatives with multiple work streams and project dependencies.
Organization Detailed Description of Services/Experience Start Date End Date No. Years
3.2 References Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
3.3
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 6 of 13
Section 4. Technical Lead Candidate
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
4.1 Eight (8) years of experience with foundational technology components including Rules Engines, Workflow Engines, IVR technology, Business Intelligence, Data Warehouse
Organization Detailed Description of Services/Experience Start Date End Date No. Years
4.2 Five (5) years of experience as a technical lead on a large scale application development efforts utilizing an architecture-based approach
Organization Detailed Description of Services/Experience Start Date End Date No. Years
4.3 Demonstrated experience with TOGAF®, NHSIA, and/or MITA Organization Detailed Description of Services/Experience Start Date End Date No. Years
4.4 Demonstrated experience working on projects with large scale networking, infrastructure, and database requirements
Organization Detailed Description of Services/Experience Start Date End Date No. Years
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 7 of 13 4.5 Demonstrated experience with the SDLC toolset such as requirements management tool, defect management
tool etc.Organization Detailed Description of Services/Experience Start Date End Date No. Years
4.6 References Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 8 of 13
Section 5. Application Architect Candidate
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
5.1 Five (5) years of experience in implementing solutions following Enterprise Architecture standards such as TOGAF®, and with EA methodologies, tools and approaches
Organization Detailed Description of Services/Experience Start Date End Date No. Years
5.2 Implementation experience must be with Rules Engines, Workflow Engines, IVR technology, Business Intelligence, and/or Data Warehousing
Organization Detailed Description of Services/Experience Start Date End Date No. Years
5.3 Demonstrated experience/capability to provide guidance in a complex technical environment integrating with multiple technologies and COTS products and ensure the development of a reliable, scalable and manageable solution.
Organization Detailed Description of Services/Experience Start Date End Date No. Years
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 9 of 13 5.4 References
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 10 of 13
Section 6. Program Area Expert Candidate (1)
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
6.1 Ten (10) Years operational experience with federally supported State programs.Organization Detailed Description of Services/Experience Start Date End Date No. Years
6.2 References Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 11 of 13
Section 7. Program Area Expert Candidate (1)
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
7.1 Ten (10) Years operational experience with federally supported State programs.Organization Detailed Description of Services/Experience Start Date End Date No. Years
7.2 References Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 12 of 13
Section 8. Program Area Expert Candidate (2)
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
8.1 Ten (10) Years operational experience with federally supported State programs.Organization Detailed Description of Services/Experience Start Date End Date No. Years
8.2 References Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Office of General ServicesNYS Procurement
Group 73012 – RFP 22822Business Advisory Services for the Integrated Eligibility System
Attachment 12 – Key Personnel Experience and Reference Form Page 13 of 13
Section 9. Program Area Expert Candidate (3)
Candidate Name
Employer of Record
Certified NYS Minority Business Enterprise Certified Women Business Enterprise
9.1 Ten (10) years operational experience with federally supported State programs.Organization Detailed Description of Services/Experience Start Date End Date No. Years
9.2 References Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
Client Name
Contact Name
Contact Title
Phone Number
Engagement TermStart End
Briefly describe the type and scope of services of the engagement.
