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EXHIBIT D <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR MEDICAL SERVICES REVIEW PROGRAM <br />REFERENCES <br />List and describe fully the contracts performed by your firm which demonstrate your ability to provide the supplies, <br />equipment or services included in the scope of the proposal specifications. Attach additional pages if required. <br />The City reserves the right to contact each of the references listed for additional information regarding your firm's <br />qualifications. <br />Reference <br />Customer <br />Address: <br />Contract Amount: <br />Description of supplies, equipment, or services provided: <br />Reference <br />Customer <br />Address: <br />Contact Individual: <br />Phone Number: <br />Facsimile Number: <br />Year: <br />Contact Individual: <br />Phone Number: <br />Facsimile Number: <br />Contract Amount: Year: <br />Description of supplies, equipment, or services provided: <br />Reference <br />Customer <br />Address: <br />Contract Amount: <br />Description of supplies, equipment, or services provided: <br />Contact Individual: <br />Phone Number: <br />Facsimile Number: <br />Year: <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />City of Santa Ana Human Resources Department <br />RFP for Medical ServiccessReview— August 27, 2018 <br />267227 <br />