ࡱ> k qbjbj88 :xRbxRbQw h.h.h.h.h.|.|.|.8.0|.w~6=(===B?CE{{{{{{{$ab|h.GB?B?GG|h.h.==H1~OOOGh.=h.={OG{OOo0Nr=PH,AuH q${G~0w~.q y?I:yHNrNryh. sF"GOG0GFFF||yL.FFFw~GGGGyFFFFFFFFF B .-:  INVITATION TO TENDER DIRECT PAYMENT SUPPORT SERVICE TENDER REF: CCBC/DP/2023 Submission Date: 23/01/2023 (5pm) Tender Submission 1. Basic Information 3 2. Subcontracting and Consortia . 5 3. Financial .. 5 4. Insurance ..... 6 5. Previous Experience and Specialist Skills . 7 6. Capacity and Commercial Aspects . 10 7. Service Specific Information . 11 8. Presentations .... 13 9. Quality Assurance . 13 10.Other Information Required . 14 11.Price Schedule ... 17 Appendix 1. Reference Proforma Appendix 2. Form of Tender Appendix 3. Declaration Appendix 4. Anti Collusion Certificate Appendix 5. Contract conditions acceptance Appendix 6. Conflict of Interest Declaration Appendix 7. GDPR, Processing of Personal Information TENDER SUBMISSION 1. Provider Information Name of Tendering Organisation ( Tenderer ):  FORMTEXT       Address to which correspondence should be sent:  FORMTEXT       Name and contact details of person applying on behalf of the Tenderer: Name:  FORMTEXT      Position:  FORMTEXT      Tel No:  FORMTEXT      Fax No:  FORMTEXT      E-mail Address:  FORMTEXT       Registered address of (if different from 1.2):  FORMTEXT       Registered website address (if applicable)  FORMTEXT       Company Registration Number:  FORMTEXT       DUNS number (if applicable)  FORMTEXT       Are you a Small, Medium or Micro Enterprise (SME)  FORMTEXT       VAT registration number:  FORMTEXT       1.10 Status of the Applicant (tick as appropriate): Sole Trader FORMTEXT      Partnership FORMTEXT      Private Limited Company FORMTEXT      Public Limited Company FORMTEXT      Co-operative FORMTEXT      Charity FORMTEXT      Other (please specify)  FORMTEXT       1.11 Date Incorporated  FORMTEXT      1.12 Is your organisation an affiliate or subsidiary of another organisation or holding organisation? If yes, please provide details. Details of immediate parent company including full name of the immediate parent company, registered office address (if applicable), registration number (if applicable), head office DUNS number (if applicable), head office VAT number (if applicable). Please enter N/A if not applicable.  FORMTEXT      1.13 Please provide details of ultimate parent company including full name of the ultimate parent company, registered office address (if applicable), registration number (if applicable), head office DUNS number (if applicable), head office VAT number (if applicable). Please enter N/A if not applicable.  FORMTEXT       1.11 Is your organisation accredited or registered with a regulatory body i.e. CIW and if so please detail below and provide a copy of your Statement of Purpose as submitted to the CIW, your registration certification or evidence of being in the process of registration and a copy of your last inspection report.  FORMTEXT       1.12 Please provide Charities or Housing Association or other Registration number (if this applies). Please specify registering body. Registering body FORMTEXT      Registration number FORMTEXT       1.13 Please provide the address of the office, branch or premises from which the management activities would be undertaken in respect of the Service (if different from 1.2). Address  FORMTEXT      Postcode FORMTEXT       2. Subcontracting and Consortia All Organisations should answer question 2.1. Where an Organisation at this stage of the process intends to sub-contract they should also answer questions 2.2 and 2.3 below. Where an Organisation becomes aware of the intention to subcontract at later stages in the procurement they are required to notify the Authority of this and provide the information requested below at that time. Where an Organisation is a consortium they should indicate which members are proposing to deliver the services. Please tick the box below which applies a) Your Organisation is bidding to provide the services required itself (if ticked, go to Section 3 - Financial)b) Your Organisation is bidding in the role of Prime Contractor and intends to use third parties to provide some servicesc) The Organisation is a consortium  2.2 If your answer to 2.1 is (b) or (c) please indicate in the table below (by inserting the relevant company/Organisation name) the composition of the supply chain, indicating which member of the supply chain (which may include the Organisation itself) will be responsible for the elements of the requirement. Company / Organisation RequirementHow much of the requirement and what will they directly deliver (%) If your answer to 2.1 is (b) and you are unable to confirm all sub-contractors (complete supply chain) at this stage, you will need to demonstrate a satisfactory methodology and track record of delivery. Please give a brief outline on policy regarding the use of sub-contractors and, if applicable, the extent to which it is envisaged they may be used in any contract. Methodology for delivery and use of sub-contractors ([300] words or fewer) (if applicable)  3. Financial A financial appraisal will be carried out in respect of all Tenderers which will be risk assessed to determine the Applicants suitability. The Authority will seek to obtain financial information in respect of each Applicant through Equifax credit report and/or Dunn and Bradstreet to assist with the assessment process. 3.1 Are you able to provide a copy of your audited accounts for the last three years, if requested? If the answer is no, can you provide one of the following: answer with Y/N in the relevant box. Yes &No &(a) A statement of the turnover, Profit and Loss Account/Income Statement, Balance Sheet/Statement of Financial Position and Statement of Cash Flow for the most recent year of trading for this organisation. Yes &No &b) A statement of the cash flow forecast for the current year and a bank letter outlining the current cash and credit position.Yes &No &c) Alternative means of demonstrating financial status if any of the above are not available (e.g. forecast of turnover for the current year and a statement of funding provided by the owners and/or the bank, charity accruals accounts or an alternative means of demonstrating financial status).Yes &No &Please advise below the date of your last filed accounts: --/--/-- 3.2 Has your organisation met all its obligations to pay its creditors and staff during the past year? If  No , please explain why not: Yes &No &3.3 If you have indicated that you are part of a wider group, please provide further details below: Name of organisation Relationship to the Organisation completing these questions Are you able to provide parent company accounts if requested?Yes & No & If yes, would the parent company be willing to provide a guarantee or performance bond if necessary?Yes & No & If no, would you be able to obtain a guarantee elsewhere (e.g. from a bank)? Yes & No &  Insurance Please provide evidence of the employers' liability, public liability insurance [and professional liability or indemnity if appropriate] held by the service Provider.Applicants who self-certify that they meet the requirements to these questions will be required to provide evidence if they are successful at contract award stage. The evidence should include the name of the insurers, policy numbers, expiry dates and limits for any one incident and annual aggregate capsand the excesses under the policies. It will be a condition of the award of contract that the successful organisations shall agree to the below required minimum levels of insurance and indemnify the Authority against all claims arising from the commission, whether caused by negligence or otherwise during the lifetime of the contract. It is an essential requirement to have the Employers Liability and Public Liability Insurance as detailed below. Where services are jointly commissioned with the Health Board, there is a requirement to ensure Medical Malpractice cover is in place (or equivalent). Please self-certify whether you already have, or can commit to obtain, prior to the commencement of the contract, the levels of insurance cover indicated in 4.1, 4.2 and 4.3 below.Yes & No &  4.1 Employers Liability Insurance (must be 10m (min.) each and every claim; unlimited in any one year): Name of insurerAddressType of insurancePolicy numbersExpiry dateLimits of indemnity (per occurrence and aggregate)Excess (if any)4.2 Public Liability Insurance (must be 10m (min.) each and every claim; unlimited in any one year): Name of insurerAddressType of insurancePolicy numbersExpiry dateLimits of indemnity (per occurrence and aggregate)Excess (if any) 4.3 Other insurance as applicable e.g. Medical malpractice cover or equivalent (please provide details) Name of insurerAddress Type of insurancePolicy numbersExpiry dateLimits of indemnity (per occurrence and aggregate)Excess (if any) 4.4 Other insurance as applicable e.g Professional Indemnity Name of insurerAddress Type of insurancePolicy numbersExpiry dateLimits of indemnity (per occurrence and aggregate)Excess (if any) 5. Previous Experience and Specialist Skills 5.1 Please set out below the experience of your organisation. You should include in your answer a brief history of your organisation and details of previous similar contracts to demonstrate your experience and specialist skills relevant to the requirement.  FORMTEXT       Please demonstrate your managerial and organisational track record including setting up, delivering and managing a direct payments support service.  FORMTEXT        Please provide your experience of supporting people with varied needs to successfully managing their direct payments.  FORMTEXT        References Please provide written references (minimum one but no more than three) and attach the completed reference to the tender submission or alternatively request the references to be submitted by the referee directly at the email address set out in the proforma attached in Appendix 1. Service Providers should ensure that the companies/organisations are willing to discuss the service Providers performance with the Authority. The Authority reserves the right to contact any or all of these companies to seek clarification. Please send the attached Reference Proforma (Appendix 1) to your Referee/s (at least 1 but no more than three) for completion and inclusion with your tender submission. ReferenceOrganisation/Local Authority NameAttached to Tender submission Yes/ No1. FORMTEXT       FORMTEXT       6. Capacity & Commercial Aspects 6.1 What is the current total number of personnel regularly and permanently employed by your organisation? (This criteria is for information purposes only). Type of JobNo of EmployeesType of JobNo of EmployeesExecutive/Managerial FORMTEXT      Administrative/Clerical FORMTEXT      Design & Development FORMTEXT      Support FORMTEXT      Service / Project workers FORMTEXT      Other FORMTEXT      Please provide a brief explanation of the geographical area where your staff are located (For Information only) 6.2 Please detail your organisation staff turnover for the last 12 months. In your response we will be looking for evidence of the ability to retain suitably skilled and qualified staff. If there has been a high turnover of staff, you may wish to provide an explanation. (This criteria is for information purposes only). 6.3 Please advise what mechanism is in place by your organisation to ensure people receiving the service are safeguarded. Your response should clearly outline the systems and processes in place to safeguard people from the risk of abuse. 6.4 Please list below the experience, qualifications and length of service of any existing staff including managers and co-ordinators that you would consider for this contract. Please expand the list as required and use bullet points where possible. Staff TitleExperienceMain qualifications FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       7. SERVICE SPECIFIC INFORMATION 7.1 Please describe your proposal for successfully delivering the direct payment support service in Conwy in line with the requirements set out in the Service Specification.  FORMTEXT       7.2 Please describe how your proposal fosters creativity and innovation in facilitating a proactive, vibrant and dynamic direct payment support service. The response should provide indicative areas for development, identifying creative and cost-effective ways to meet individuals goals.  FORMTEXT       7.3 Please advise how you will ensure your service has a strong presence in Conwy and accessible in a variety of ways, minimising delays and ensuring responsiveness. The response should take account of the variety of communication methods and to meet a range of needs across all service areas including children and families, disabilities, older people etc  FORMTEXT       Please describe how you would ensure appropriate levels of support is provided to direct payment recipients as and when they need it, promoting their independence as far as possible and responding to their fluctuating needs for assistance.  FORMTEXT       7.5 Please advise how you will support direct payment recipients to become good employers.  FORMTEXT       7.6 Please provide a clear indication of the overall team including the number of suitably trained staff that would be dedicated to this Service, taking into accounts staff absences, sickness etc. Please detail or include as a separate document, a clear structure, identifying their remit, roles and responsibilities relevant to this Service. This should clearly indicate existing commitments (if applicable) within the Organisation and ability to respond in an emergency.  7.7 Please outline the training requirements and how Staff will be supported to enable them to enhance their skills and expertise.  7.8 Please advise how the quality of the overall service will be monitored. Your response should outline clear governance arrangements you have in place to ensure the service is effective and how you will proactively promote continuous improvement to ensure the service does not become stagnated but offers an innovative approach to service delivery.  7.9 Please detail how complaints, conflict and issues will be addressed taking into account the diverse needs of individuals. Your response should include the systems that you have in place and/or aim to introduce, effective communication with Commissioners, partnership working with both Local Authorities and reporting including escalation processes.  8. PRESENTATION Providers may be asked to attend a virtual meeting to clarify certain aspects of the tender, however it is not anticipated that a presentation would be required. 9. SOCIAL VALUE 9.1 Please details below how your organisation aims to make improvements to the social, economic and environmental well-being e.g. help others in the community, opportunities for disadvantaged individuals. creating job opportunities in the local area, voluntary work, apprenticeships, protecting and preserving the local environment, reducing carbon footprint etc.  10. OTHER INFORMATION RefQuestionYesNo1As an employer, do you have an Equal Opportunities Policy that complies with all current legislation as set out in the Equality Act 2010? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 2As an employer, do you comply with the requirements set out in the Equality Act 2010 and if appropriate, the Statutory Duties (Wales) Regulations 2011 (relevant to public sector Organisations)? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 3As an employer, do you comply with the requirements placed on you to make reasonable adjustments for disabled people under the Equality Act 2010? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 4In the last 3 years, has your Organisation been investigated by the Equality and Human Rights Commission because of allegations of unlawful discrimination? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 5In the last 3 years, has any Court or Employment Tribunal found that your Organisation has discriminated against someone because of their identity connected with a protected characteristic (sex, race, disability, age, religion or belief, gender reassignment, sexual orientation, marriage / civil partnership or pregnancy / maternity) under the Equality Act 2010 or previous equality legislation? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 6In the last 3 years, has any Court or Employment Tribunal found that your Organisation has discriminated against someone in relation to the level of pay you gave them because of a protected characteristic under the Equality Act 2010 or previous equality legislation? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 7Is your Organisation able to provide evidence of monitoring and promoting Equal Opportunities and adhering to Equality and Human Rights Legislation? Ifyes, would you be able to provide examples of any monitoring undertaken if requested?  FORMCHECKBOX  FORMCHECKBOX 8In the last three years, has your Organisation been investigated by the Employment Agencies Standards Inspectorate? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 9Has your Organisation, or any subsidiary, been the subject of a successful Employer Liability or Public Liability claim against you, whether settled privately or through your insurers within the last three years? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 10Do both your Employers and Public Liability Insurance Policies include a Principals clause that would indemnify the Council in the event of claims arising from your activities whilst providing this service? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 11Have any of your contracts been terminated for poor performance in the last three years? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 12In the last three years, has your Organisation not had a contract renewed due to failure to perform the terms of the contract? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 13In the last three years, has your Organisation become involved in any litigation in respect of a contract or its delivery? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 14Do any of the following apply to your Organisation: Been committed for an act of gross misconduct in the course of delivering services? Is guilty of serious misrepresentation in supplying information? Is not in possession of relevant licences or membership of an appropriate Organisation where required by law? If yes, to any answer, please supply details.  FORMCHECKBOX  FORMCHECKBOX 15Is there any business, establishment or person who has, or may have, any right(s) of veto over your Organisations decision-making whether operational or financial? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 16Does your Organisation have a documented Health and Safety Policy? If yes, would you be able to provide a copy if required?  FORMCHECKBOX  FORMCHECKBOX 17Does your Organisation have a recognised Health and Safety Manager or a nominated person with responsibility for Health and Safety? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 18Does your Organisation have the following documents: Risk Assessment and Method Statement or Safe Systems of Work document? If yes, would you be able to provide a copy if required?  FORMCHECKBOX  FORMCHECKBOX 19Is your Organisation accredited by, or is your Organisation working towards, a Contractor Assessment scheme that is a member of the Safety Scheme in Procurement (SSIP)? Please supply details: If the answer is NO, please advise if you would be willing to obtain such an accreditation.  FORMCHECKBOX  FORMCHECKBOX 20Does your Organisation have a documented Environmental policy? If yes, would you be able to provide a copy if required?  FORMCHECKBOX  FORMCHECKBOX 21Does your Organisation have any association (either directly or indirectly) with any Member or employee of Conwy County Borough Council? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 22Do you have the facility or experience of being able to engage with people in the Welsh language? If yes, please supply details.  FORMCHECKBOX  FORMCHECKBOX 23Do have a data protection policy and procedures that is compliance with the General Data Protection Regulations and the Data Protection Act 2018? If yes, would you be able to provide a copy if required?  FORMCHECKBOX  FORMCHECKBOX 24Does your Organisation comply with the requirements of General Data Protection Regulations (GDPR)? If asked, can you provide evidence of compliance, policy, employee training for GDPR, etc? Please supply details:  FORMCHECKBOX  FORMCHECKBOX 25Does your Organisation comply with the principles of the Well-being of Future Generations (Wales) Act 2015? If yes, could you provide a statement to confirm your compliance with this Act. Please supply details:  FORMCHECKBOX  FORMCHECKBOX 26Does your Organisation comply with the requirements set out in the Code of Practice Ethical Employment in the Supply Chain? Please supply details:  FORMCHECKBOX  FORMCHECKBOX 27Does your Organisation have a Safeguarding policy? Please supply details FORMCHECKBOX  FORMCHECKBOX  11. Price Schedule Tenderers are required to set out the Price at which they are willing to provide the service. The Contract shall be formed on the basis of the Tender Price submitted in the Form of Tender. The Tender Price submitted in the Form of Tender will be the all inclusive Tender Price applicable for all service management related functions relevant to the service, including recruitment, administration, management, co-ordination, monitoring, supervision, training etc. A full breakdown of the Tender Price will be required to be submitted by the Tenderer to detail the price components per annum. All monetary values shall be in Pounds Sterling (to two decimal places) excluding VAT. APPENDIX 1 abcde REQUEST FOR REFERENCE DIRECT PAYMENT SUPPORT SERVICE Conwy County Borough Council is currently undertaking a tender exercise for the provision of a direct payment support service. The Organisation below has expressed an interest in being considered for this tender and has named you as a referee. In support of the tender process please complete this form and provide the completed reference to the organisation for submission (submission date: XXXX) or alternatively please submit the reference directly to Conwy County Borough Council at the email address detailed below by no later than XXXX. Please answer the questions to the best of your knowledge. The information will be shared with members of the Tender Evaluation Panel. To be completed by the Applicant requesting a reference: Name of Organisation: Address of Organisation: Date of request submitted: Please provide comments in respect of the following:1. The nature of your relationship with the above Organisation  2. The service delivery of the organisation 3. Your relationship and partnership working with this Organisation 4. The quality of service provision of this Organisation within your area and outcomes achieved  5. Any complaints or other issues which have not been resolved in respect of this Organisation? If yes, please give details. 6. Have there been any compliments or achievements in the last 3 years that you wish to raise in support of the Organisations tender application? If yes please give details. 7. Have you identified any areas for improvement in the last 3 years that is relevant in respect of the operation and running of the services by this Organisation? If yes please give details. 8. Based on your experience, would you recommend this Organisation to deliver a direct payment support service? Please select accordingly: Please answer and comment accordingly: Yes................................................................................................................................................. ....................................................................................................................................................... No................................................................................................................................................... ....................................................................................................................................................... Unsure............................................................................................................................................ ....................................................................................................................................................... This reference was completed by: DateName and Designation/Job title:Organisation:Contact Telephone No: Contact Email Address: Please return this Reference to: Anita Williams, Contracts and Procurement Officer Conwy County Borough Council, Bodlondeb, Bangor Road, Conwy Email address at  HYPERLINK "mailto:anita.williams@conwy.gov.uk" anita.williams@conwy.gov.uk Please telephone 01492 574114 if you wish to discuss the reference request Thank you for your support and co-operation Date:  FORMTEXT       APPENDIX 2 Form of Tender To: Conwy County Borough Council TENDER FOR THE SUPPLY OF SERVICES 1. I / we have read the information provided in your Invitation to Tender and, subject to and upon the terms and conditions contained therein, I / we offer to supply the above as described in the said tender documents in such manner as may be required. 2. Terms and Conditions: I / we agree that this tender and any contract which may result there from shall be based upon the Local Authorities General and Specific Conditions of Purchase available. 3. The prices quoted in this Tender are valid for acceptance for 60 days from the final day for submission of Tenders and I / we confirm that the terms of the Tender will remain binding upon me / us and may be accepted by you at any time before that date. 4. I / we agree that the construction, validity, performance and execution of any contract that may result from this Tender shall be governed by and interpreted in accordance with English Law and shall be subject to the exclusive jurisdiction of the Courts of England and Wales. 5. I / we agree to bear all costs incurred by me / us in connection with the preparation and submission of this Tender and to bear any further costs incurred by me / us prior to the award of any contract. 6. I / we agree that any other terms or conditions of the agreement or any general reservation which may be printed on any correspondence emanating from me / us in connection with this tender, shall not be applicable to this Tender or Contract. 7. I / we hereby propose and undertake to deliver the Contract required to be performed in accordance with the Tender Specification, at a cost of _ FORMTEXT      ________________________________two year tender price (excluding VAT) The above two year (24 months) tender price represents the management associated with the direct payment support service. The submission should include a detailed summary of all associated costs per annum. Please confirm the variation rate in the event of an increase /decrease in service: & & & & & & & & & & & XXXX Date: _ FORMTEXT      ___ Signature:______________________________ Print Full Name: _ FORMTEXT      __ In the capacity of: _ FORMTEXT      __ (Please state official position, e.g. Director, Sales Manager, etc.) being a person duly authorised to sign tenders on behalf of: Company Name:  FORMTEXT      _ Address:  FORMTEXT      _ Appendix 3 Declaration In this certificate, any reference to person or persons shall mean and include businesses, associations or corporations and any reference to arrangements or agreements shall mean any and all transactions, formal or informal, lawful or otherwise. I / We certify that: We have not been convicted of nor are currently under investigation for any acts of conspiracy, corruption, bribery, fraud, money laundering, such acts as defined by the relevant UK law, nor any other offence within the meaning of Article 45(1) of the Public Sector Directive. We are not bankrupt nor have had a receiving order or administration order or bankruptcy restrictions order made against us nor are in the process of or about to commence any composition or arrangement with or for the benefit of our creditors or, if registered as a partnership under Scots law, have not been granted a trust deed or is subject of a petition for sequestration of our estate. We have not, nor are about to, be subject of a resolution or order for winding up, nor have has a receiver, manager or administrator. We have not been convicted of a criminal offence relating to the conduct of our business or (being an individual) not been guilty of grave misconduct in the course of its business. We have fulfilled our obligations relating to the payment of social security contributions and the payment of taxes in accordance with the legal provisions of the country in which it is established and / or the United Kingdom. We have not been found guilty of serious misrepresentation in providing any information under Regulation 57 of the Public Contract Regulations 2015. We have not suffered a deduction for liquidated or ascertained damages in respect of any contract nor had a contract cancelled, or not renewed, for failure to perform nor been the subject of a claim (contractual or otherwise) based upon a failure of quality in design, work, materials or services within the last three years. None of the senior personnel of the Organisation have been involved (in a similar position) in any company which has gone into insolvent liquidation, voluntary arrangement, receivership or administration or been declared bankrupt. We comply with the requirements of the Equality Act 2010 and previous equality legislation and, if appropriate, the Statutory Duties (Wales) Regulations 2011. We promote Equal Opportunities and adhere to Equality and Human Rights Legislation. There are no mandatory and exclusion grounds for excluding their organisation in accordance with Regulation 57 set out on this  HYPERLINK "https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/551130/List_of_Mandatory_and_Discretionary_Exclusions.pdf" webpage of the Public Contracts Regulations 2015. I / We confirm and attest that the foregoing information and declarations are accurate to the best of my / our knowledge and that I / We acknowledge and accept that any false information could result in our application being rejected, or, in the event that any false declaration is discovered after the award of any contract, may lead to the rescission of any contract awarded. Signature: _____________________________________________________________________ Name (printed): _________________________________________________________________ Dated: ________________________________________________________________________ Capacity / Title: _________________________________________________________________ For and on behalf of: _____________________________________________________________ Address: _______________________________________________________________________ Appendix 4 ANTI COLLUSION CERTIFICATE I/we certify that this tender is made in good faith, and that we have not fixed or adjusted the amount of the tender by or under or in accordance with any agreement with any other person. 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<$da$gd~n with the tender to any other party (including any other company or part of a company forming part of a group of companies of which I am/we are a part) nor to any sub-contractor (whether nominated or domestic) nor supplier (whether nominated or domestic) or any other person to whom such disclosure could have the effect of preventing, restricting or distorting competition in this tendering exercise (ii) enter into any agreement or arrangement with any person that they shall refrain from tendering, that they shall withdraw any tender once offered or vary the amount of any tender to be submitted (iii) otherwise collude with any person with the intent of preventing, restricting or distorting competition; (iv) pay, give or offer to pay or give any sum of money or other valuable consideration directly or indirectly to any person for doing or having done or causing or having caused to be done in relation to any other tender or proposed tender for the work any act or thing of the sort described at (i), (ii) or (iii) above. I/we further declare that I/we have no knowledge either of the sum quoted or of any other particulars of any other tender for this contract by any other party. We further certify that the principles described above have been, or will be, brought to the attention of all sub-contractors, suppliers and associated companies providing services or materials connected with the tender and any contract entered into with such sub-contractors, suppliers or associated companies will be made on the basis of compliance with the above principles by all parties. I/we acknowledge that any breach of the foregoing provisions shall lead automatically to this tender being disqualified and may lead to criminal or civil action. Conwy County Borough Council shall treat any tender received in confidence but reserves the right to make same available to any relevant Department of the Council, other Local Authority Trading Standards Department, the Director General of Fair Trading, and/or any other statutory regulatory authority either having jurisdiction over the work or who may now or at any time in the future have statutory power to require disclosure of this tender. In this certificate, the word person includes a body of persons corporate or unincorporated and any undertaking for the purposes of The Competition Act 1998; any agreement includes any transactions, formal or informal and whether legally binding or not; and the work means the work or goods or services in relation to which this tender is made. Signature: _____________________________________________________________________ Name (printed): _________________________________________________________________ In the capacity of (e.g. Director, Secretary, etc.): ________________________________________ Date: _________________________________________________________________________ Duly authorised to sign tenders and acknowledge the contents of the Anti-Collusion Certificate for and on behalf of: - Name of Company: ______________________________________________________________ Full postal address: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Telephone Number: ______________________________________________________________ Fax Number: ___________________________________________________________________ E-mail: ________________________________________________________________________ APPENDIX 5 Conflict of Interest Declaration The Authority reserves the right to reject Tenderers as ineligible where we perceive an actual or potential conflict of interest. In responding to the questions below the signatory is to include in its consideration of any matters, private interests or relationships which could or could be seen to influence any decisions taken or to be taken, or the advice you are giving to the Authority, or that may result in an adverse impact on competition for the purposes of this procurement. The types of interests and relationships that may need to be disclosed include investments, shareholdings, trusts or nominee companies, company directorships or partnerships, other significant sources of income, significant liabilities, gifts, private business, employment, voluntary, social or personal relationships that could or could be seen to impact upon your responsibilities and existing or previous involvement that could create a potential, actual or perceived conflict. The Tenderer should also notify the Authority where it or another part of its business has advised The Authority on this project or programme previously. If your response is yes to any of the questions below, please provide full details as a separate attachment. QuestionsYes / No Are you (the Tenderer) affiliated or otherwise connected (e.g. in joint venture whether incorporated or unincorporated, partnership, alliance or as a sub-Tenderer/sub-contractor) with any firm that supplies products, works or services to the Authority or is currently tendering to do so? In the past 12 months, to the best of your knowledge, has any member of your organisation or your supply chain had any direct or indirect involvement (by way of trading, sharing information, participating in industry for or jointly delivery goods/works/services) with any other company acting as a supplier to the Authority? At any time in the past 12 months, to the best of your knowledge, has any member of your organisation or supply chain received any gift (other than promotional items) or hospitality from a supplier or employee of the Authority?Is there any occasion where you or members of your organisation or supply chain may use the Authority resources (equipment, space, supplies or paid individuals) in performing paid or unpaid activities for organisations other than the Authority.Are there any other activities not reported under the previous questions that may give rise to a conflict of interest with respect to their work with the Authority e.g. through personal or working relationships with current or former employees or through prior employment with the Authority or third party suppliers? I, as representative of all companies associated with the Tenderers submission, hereby confirm that I have read and understood the above statements and that I will make full disclosure of interests, relationships and holdings that could potentially result in a conflict of interest. I agree that if I become aware of any information that might indicate that this disclosure is inaccurate, I will notify the Authority promptly and no later than 28 days after becoming aware of such information and undertake to take such action as the Authority may reasonably direct. Signature: Name: Designation: Organisation: Date:  APPENDIX 6 PROCESSING OF PERSONAL INFORMATION (Please complete the highlighted sections) Please detail in this section the required Personal Information to be processed as part of this Contract in accordance with the terms and conditions of the Contract: Subject matter of the processing Processing of personal information as part of the delivery of the Direct Payments Support Service Duration of the processing 2 years in line with the terms of the contract. Nature and purposes of the processing To provide a support service to Direct Payment recipients. 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