ࡱ> O bjbj*8*8 :ZHRWiHRWiPxgL L 8*EL(\304E6E6E6E6E6E6E$GQJZEcccZEoEg%g%g%c^4Eg%c4Eg%g%R=<l@PgOg'> EE0E ?b KK$ K<l@l@8 K@|ccg%cccccZEZE$pcccEcccc KcccccccccL X :  Qualification Questionnaire i)Please provide your name and contact details: including the registered address and company name of the company you are submitting this tender on behalf of. Provide the name and contact details of the person you would like the buyer to liaise with regarding this tender.  SECTION A - SUPPLIER ACCEPTABILITY QuestionSupplier Guidance Answer1Regulation 57 (1-7) of the Public Contracts Regulations 2015 sets out grounds on which a bidding organisation must be deemed ineligible to tender for, or be awarded, a public contract. Within the past five years, has your organisation (or any member of your proposed consortium, if applicable), Directors or partner or any other person who has powers of representation, decision or control been convicted of any of the following offences? conspiracy; corruption; bribery (common law offence); bribery within the meaning of section 1, 2 or 6 of the Bribery Act 2010, or section 113 of the Representation of the People Act 1983; fraud, including - cheating the Revenue; conspiracy to defraud; fraud or theft; fraudulent trading; defrauding the Customs/HMRC; an offence in connection with taxation in the European Union; destroying, defacing or concealing of documents; fraud within the meaning of section 2, 3 or 4 of the Fraud Act 2006; or the possession of articles for use in frauds, or the making, adapting, supplying or offering to supply articles for use in; any offence listed- in section 41 of the Counter Terrorism Act 2008 in Schedule 2 to that Act where the court has determined that there is a terrorist connection; any offence under sections 44 to 46 of the Serious Crime Act 2007 which relates to an offence covered by paragraph (f) money laundering; an offence in connection with the proceeds of criminal conduct; an offence under section 4 of the Asylum and Immigration Act 2004; an offence under section 59A of the Sexual Offences Act 2003; an offence under section 71 of the Coroners and Justice Act 2009; an offence in connection with the proceeds of drug trafficking; or any other offence within the meaning of Article 57(1) of the Public Contracts Directive. The buyer will not select you to tender if any of the mandatory grounds for exclusion apply, unless you have included an adequate explanation and/or mitigating factors in SA.GEN01b You should check the full text of Regulation 57 of the Public Contracts Regulations 2015 and take legal advice where appropriate. The buyer may make its own checks and will require you to provide a record of convictions by responding to question SA.GEN01b.  HYPERLINK "http://www.legislation.gov.uk/uksi/2015/102/contents/made" http://www.legislation.gov.uk/uksi/2015/102/contents/made If you are bidding as, or on behalf of, a consortium, you should check with all members of the consortium whether or not these grounds for exclusion apply. Select Yes if these grounds apply to any consortium member. NB: If any of the mandatory grounds for exclusion become applicable after data has been submitted for a contract, you must inform the buyer. Failure to do so may cause any contract awarded to be terminated. YES/NO2Within the past five years has it been established by a judicial or administrative decision having final and binding effect in accordance with the legal provisions of any part of the United Kingdom or the legal provisions of the country in which your organisation is established (if outside the UK), that your organisation is in breach of obligations related to the payment of tax or social security contributions? The buyer will use this information to determine whether the mandatory grounds for exclusion apply to your organisation. If such grounds apply, your organisation will be automatically excluded unless you can demonstrate evidence of your acceptability despite the existence of these grounds for exclusion. This would include adequate evidence of self-cleaning (see Regulation 57 (13)- (17)) The measures you have taken will also be evaluated taking into account the gravity and particular circumstances of the criminal offence or misconduct. If you are bidding as, or on behalf of, a consortium, you should check with all members of the consortium whether or not these grounds for exclusion apply. Select Yes if these grounds apply to any consortium member. YES/NO3Regulation 57 (8) of the Public Contracts Regulations 2015 sets out discretionary grounds on which a bidding organisation may be deemed ineligible to tender for, or be awarded, a public contract. Should it become apparent to the buying organisation that any of the following situations has applied to your organisation within the past 3 years, or currently applies to your organisation, you may be excluded from the procurement. Select Yes if you wish to discuss any of these matters with the buying organisation. your organisation has violated obligations in the fields of environmental, social and labour law; your organisation is bankrupt or is the subject of insolvency or winding-up proceedings; your organisation is guilty of grave professional misconduct, which renders its integrity questionable; your organisation has entered into agreements with other economic operators aimed at distorting competition; your organisation has a conflict of interest with the buying organisation which cannot be remedied; the prior involvement of your organisation in the preparation of the procurement procedure has resulted in a distortion of competition which cannot be remedied; your organisation has shown significant or persistent deficiencies in the performance of a substantive requirement under a prior public contract which led to early termination of that prior contract or damages; your organisation has been guilty of serious misrepresentation in supplying information during a procurement exercise, or has withheld such information or is not able to submit the supporting documentation; or your organisation has attempted to unduly influence the decision-making process of the contracting authority, or to obtain confidential information; or has negligently provided misleading information that may have a material influence on decisions concerning exclusion, selection or award. The buyer may exclude you from participation in a procurement procedure if, having investigated the circumstances, any of these grounds for exclusion is found to apply. If you are bidding as, or on behalf of, a consortium, you should check with all members of the consortium whether or not these grounds for exclusion might apply. The buyer may include additional questions covering some of these grounds more specifically, for example, on conflicts of interest, on employment practices such as Blacklisting and False Self-Employment and on offences under Equalities, Environmental and Health and Safety legislation. See Regulation 56(2) for more details.YES/NO4Are you (if an individual) or any of your directors, partners, shareholders, owners, officers, employees, agents or associates (if an organisation) related or connected to any elected officials of the buyer or any officers of the buyer involved in the procurement?The buyer may not select a bidding organisation to tender without first having taken steps to avoid or mitigate any conflicts of interest. NOTE: In the event that you fail to declare a potential conflict of interest the buyer may cancel any contract awarded. If you are bidding as, or on behalf of, a consortium, you should check with all members of the consortium whether any conflicts of interests apply. Select Yes if this applies to any consortium member.YES/NO5Have any of your organisations tax returns submitted on or after 1 October 2012; Given rise to a criminal conviction for tax related offences which is unspent, or to a civil penalty for fraud or evasion; or Been found to be incorrect as a result of: HMRC successfully challenging your organisation under the General Anti-Abuse Rule (GAAR) or the Halifax abuse principle; or a tax authority in a jurisdiction in which the legal entity is established successfully challenging it under any tax rules or legislation that have an effect equivalent or similar to the GAAR or the Halifax abuse principle; or the failure of an avoidance scheme in which your organisation was involved and which was, or should have been, notified under the Disclosure of Tax Avoidance Scheme (DOTAS) or any equivalent or similar regime in a jurisdiction in which your organisation is established. The buyer may deem you ineligible to tender if any of these grounds for exclusion apply. If you are bidding as, or on behalf of, a consortium, you should check with all members of the consortium whether or not these grounds for exclusion apply. Select Yes if these grounds apply to any consortium member. YES/NO6If you or your organisation has used or run prohibited lists within the last 3 years, as defined in The Employment Relations Act 1999 (Blacklists) Regulations 2010, you must disclose this. The buyer may deem you ineligible to tender unless you can demonstrate adequate evidence of 'self-cleaning' (see Regulation 57 (13) - (17)). The measures you have taken will also be evaluated taking into account the gravity and particular circumstances of the misconduct. If you are bidding as, or on behalf of, a consortium, you should check with all members of the consortium whether or not these grounds for exclusion apply. Select "Yes" if these grounds apply to any consortium member. Have you, or has your organisation been found to have employed the practice of 'blacklisting' in the last three years? YES/NO7If you have answered Yes to any of the questions 1 to 6, please provide an explanation8aWhat steps have you taken/do you plan to take to tackle modern slavery and human rights abuses within your organisation and supply chains? Can you confirm you are not subject to any ongoing investigations or charges in relation to modern slavery and/or human rights abuses? Can you confirm you are not aware of any ongoing investigations or charges within your supply chain in relation to modern slavery and/or human rights abuses? Do you provide training on modern slavery and human rights abuses for your staff involved in supply chain management? How many workers do you employ, and on what basis (e.g. direct, agency staff etc)? How do you ensure that all of your workers are aware of their rights? Can you confirm that all your workers have the right to work in the U.K? Do all of your workers have employment contracts in place? Can you confirm that all workers are paid in line with relevant national pay rates (these are the National Minimum/Living Wage rates in the UK)? The buyer may deem you ineligible to tender if you do not meet these requirements. Please attach any internal relevant policies. 8bPlease confirm that your lead architect is either a member of the Architects Accredited in Building Conservation (AABC) or a RIBA Specialist Conservation Architect (SCA). The buyer may only select you to tender if you are able to give recent evidence of your membership of the named bodies/accreditations. Please provide evidence now by way of an attachment/s or membership number if applicable. YES / NO SECTION B - ECONOMIC / FINANCIAL STANDING 9Are you registered for VAT? If so, please provide registration numberThis information is for verification only but the buyer may exclude you if you provide incorrect information. If you are not registered for VAT this will not necessarily preclude you from bidding. If you are bidding as, or on behalf of, a consortium, you should either provide the lead member's details here, or state that, if selected, the body will register and comply with relevant VAT legislation.YES/NO10Is your organisation (please indicate the option that applies): a public limited company a limited company a limited liability partnership (LLP) other partnership a sole trader a consortium other (please specify). This information will be used for identification purposes only but the buyer may exclude you if you provide incorrect information. If you are bidding as, or on behalf of, a consortium, please select this option and describe your organisation as requested, 11Provide your company or LLP registration number (if applicable).This information will be used for identification purposes only but the buyer may exclude you if you provide incorrect information.12Provide your Dun & Bradstreet (DUNS) registration number. If you are not currently registered you must obtain a free DUNS number for your business by visiting  HYPERLINK "http://www.dnb.co.uk/Forms/DUNS_Request.asp" http://www.dnb.co.uk/Forms/DUNS_Request.asp. You must either have a DUNS number, or have requested a DUNS number in order to bid. You will be obliged to have a DUNS number for verification purposes if you wish to save your responses to SQuID questions for re-use on the Sell2Wales website. If the buyer intends to use the DUNS number to obtain a failure score, or use a different credit reference agency to obtain a third-party analysis of your financial strength this will be made clear, along with any thresholds set. 13The authority requires you to have a valid Public Liability Insurance policy with an Indemnity Limit of 5,000,000 If you have Public Liability insurance provide the level of insurance or indemnity limit, Expiry date Name of insurer Policy number OR attach a copy of your Insurance Certificate4 If you do not have Public Liability of 5,000,000 but are willing to put this policy in place, please attach a valid quote from a provider, and confirm that you are willing to put the policy in place if you are successful.The buyer will only select a bidding organisation to tender if it has or will have an appropriate level of public liability insurance from an authorised provider with appropriate financial strength. See the HMRC website for details of regulation of insurance providers, and EU equivalents. If you are bidding on behalf of a consortium please include data from all relevant consortium members Please append a copy of your current valid insurance policy 14The authority requires you to have a valid Employers Liability Insurance policy with an Indemnity Limit of 5,000,000 If you have Employers Liability insurance provide the level of insurance or indemnity limit, Expiry date Name of insurer Policy number OR attach a copy of your Insurance Certificate If you do not have Employers Liability of 5,000,000 but are willing to put this policy in place, please attach a valid quote from a provider, and confirm that you are willing to put the policy in place if you are successful.  The buyer will only select a bidding organisation to tender if it holds Employer's Liability insurance (as required by legislation) from a reputable provider with appropriate financial strength. If you are bidding on behalf of a consortium please include data from all consortium members. Please append a copy of your current valid insurance policy 15The authority requires you to have a valid Professional Indemnity Insurance policy with an Indemnity Limit of 1,000,000 If you have Professional Indemnity insurance provide the level of insurance or indemnity limit, Expiry date Name of insurer Policy number OR attach a copy of your Insurance Certificate If you do not have Professional Indemnity of 1,000,000 but are willing to put this policy in place, please attach a valid quote from a provider, and confirm that you are willing to put the policy in place if you are successful. The buyer will only select a bidding organisation to tender if it holds Professional Indemnity insurance (as required by legislation) from a reputable provider with appropriate financial strength. If you are bidding on behalf of a consortium please include data from all consortium members. Please append a copy of your current valid insurance policy16 Provide the name and contact details of the person you would like the Buyer to liaise with regarding any queries about the financial position of your organisation.This is for information only, and will not be scored. If you are bidding as, or on behalf of, a consortium, you must provide all relevant contact details, or ensure that you know who to contact in the event of financial queries about other consortium members.17Has your organisation been *profitable in each of the last two financial years? * Your profitability is defined as Earnings Before Interest and Tax (EBIT). Please note. If you are successful you must be in a position to provide further evidence if required, without delay, to confirm this prior to contract award. If you are bidding as, or on behalf of a consortium your profitability should take account of all consortium members and if successful you will be required to explain how you have arrived at your answer If your organisation was not profitable in either of the last two financial years (i.e. reported a negative EBIT) please explain why, and provide evidence of how your organisation will be able to continue trading. Details you may like to provide include: Explanation of why the reported EBIT is affected by exceptional items e.g. changes to accounting practice Projected profit / loss Availability of assets to meet continued loss Projected cash flow The buyer may not select you to tender if you have not been profitable in any of the last two financial years. The buyer may make an exception if you can explain why these losses should not be seen as representing a significant risk to your financial stability. Please provide copies of your last two years of accounts and where available the very latest set of management accounts YES/NO SECTION C - CAPACITY & CAPABILITY 18What are the main business activities of your organisation or consortium? Please limit your answer to a brief summary. This answer will not be evaluated, but will be used by the buyer to understand what goods and services your organisation provides.19Has your organisation had a contract cancelled, or not renewed, for breach of contract or failure to meet requirements within the last 3 years? If you answered "yes" please provide details including name of customer, reasons for cancellation and any action taken to avoid this happening again.The buyer may use this information to determine whether you have a record of successful delivery of contracts. If you answer "yes" to this question and fail to provide convincing evidence that you have taken appropriate action to ensure the problems will not be repeated you may not be selected to tender. If you are bidding as, or on behalf of, a consortium, you should provide details for all consortium members. Select "Yes" if this applies to any consortium member.YES/NO20Have you had to pay any damages (whether liquidated (LADs) or unliquidated) for a failure to complete a contract on time or to requirements in the last three years? The buyer may use this information to determine whether you have a record of successful delivery of contracts. If you answer yes to this question and fail to provide convincing evidence that you have taken appropriate action to ensure the problems will not be repeated you may not be selected to tender. If you are bidding as, or on behalf of, a consortium, you should provide details for all consortium members Select Yes if this applies to any consortium member.YES/NO21Please confirm that you currently meet, or will meet if you are successful, the requirements of the Welsh language measure.  HYPERLINK "http://www.anglesey.gov.uk/searchresults?qsearch=1&qkeyword=welsh+language+policy" http://www.anglesey.gov.uk/searchresults?qsearch=1&qkeyword=welsh+language+policyThe buyer may only select you to tender if you confirm that you will comply with requirements to deliver services in the Welsh language. If you are successful the buyer may require you to provide evidence to support your answer. Please supply a copy of your Welsh language policyYES/NO 22Describe how you make sure that the quality of your products or services is consistent.The buyer may use your answer to determine if you have an appropriate system for making sure that the quality of the product or service you deliver is consistent. This may include Quality Management Systems such as ISO9001 If you are bidding as a consortium please ensure that, in answering this question, your system covers all consortium members. Please supply a copy of your quality management system. SECTION D - EQUAL OPPORTUNITIES 23In the last three years, has any finding of unlawful discrimination been made against your organisation by an Employment Tribunal, an Employment Appeal Tribunal or any other court (or in comparable proceedings in any jurisdiction other than the UK) and/or has your organisation had a complaint upheld following an investigation by the Equality and Human Rights Commission or its predecessors (or a comparable body in any jurisdiction other than the UK), on grounds of alleged unlawful discrimination?The buyer may not select you to tender if you have been found to have unlawfully discriminated in the last three years, unless you have provided adequate evidence that you have taken appropriate action to stop it happening again.YES/NO24If you answered yes to 23 provide a summary of the nature of the investigation and an explanation of the outcome to date. If the investigation upheld the complaint against your organisation, please explain what action (if any) you have taken to prevent unlawful discrimination from reoccurring The buyer may not select you to tender if you have been found to have unlawfully discriminated in the last three years, unless you have provided adequate evidence that you have taken appropriate action to stop it happening again25Please provide a copy of your equal opportunities policy, which details how your organisation complies with its obligations under the Equality Act 2010 and accordingly protects people from discrimination, whether in relation to recruitment, training, promotion or otherwise, on the grounds of age, disability, sex, sexual orientation, pregnancy and maternity, marriage or civil partnership, gender reassignment, religion, belief, or race (including colour, nationality or ethnic origin).The buyer may not select you to tender if you do not have a policy in place that is compliant with the Equalities Act 2010 Please attach a copy of your equal opportunities policy  SECTION E - SUSTAINABILITY 26Has your organisation been convicted of breaching environmental legislation, or had any notice served upon it, in the last three years by any environmental regulator or authority (including local authority)?The buyer may not select you to tender if you have been convicted or served notice under environmental legislation in the last three years unless you provide adequate evidence of action taken to stop similar incidences from happening again. If you are bidding on behalf of a consortium please include data from all consortium members. Select "Yes" if this applies to any consortium member.YES/NO27If your answer to 26 is yes please provide details of any of the conviction or notice and details of any remedial action or changes you have made as a result of conviction or notices servedThe buyer may not select you to tender if you have been convicted or served notice under environmental legislation in the last three years unless you provide adequate evidence of action taken to stop similar incidences from happening again. If you are bidding on behalf of a consortium please include data from all consortium members. Select "Yes" if this applies to any consortium member.28If you use subcontractor(s), or are bidding on behalf of a consortium, do you have processes in place to check whether any of these organisations have been convicted or had a notice served upon them for infringement of environmental legislation?The buyer may not select you to tender if you do not have in place adequate vetting processes to check your subcontractors' and/or consortium members' record on compliance with environmental legislation. Select "Yes" if this applies to any consortium member. In some cases this may include the need for your suppliers to have an externally-accredited environmental management system in place. 29Please confirm whether you currently hold a waste carriers license? Please attach a copy of your certificate. If you do not currently hold a waste carriers license, but are willing to obtain one if you are successful in winning the tender, please state so.The buyer may not select you to tender if you do not have a waste carriers license. More info on applying for waste carriers licenses can be found here:  HYPERLINK "http://naturalresourceswales.gov.uk/apply-and-buy/waste/register-as-a-carrier/?lang=en" http://naturalresourceswales.gov.uk/apply-and-buy/waste/register-as-a-carrier/?lang=enYES/NO SECTION F - HEALTH & SAFETY 30Has your company been served with a Prohibition or Improvement notice for any breaches of Health & Safety legislation in the last three years?The buyer may not select a bidding organisation to tender if it fails to meet this requirement. If you are bidding on behalf of a consortium please include data from all consortium members. Please ZIP documents together if necessary.YES/NO31If your answer to Q30 was "yes" provide details of the convictions or notice(s) served and give details of any remedial action or changes to procedures you have made as a result of the prosecution or notice(s) served.The buyer will not select you to tender if your company has been prosecuted or served notice under health and safety legislation unless there is clear evidence that decisive and comprehensive action has been taken to remedy the situation. The buyer may check the HSE database to confirm the accuracy of the information provided. Failure to provide accurate information may result in you not being selected to tender. If you are bidding on behalf of a consortium please include data from all consortium members.32Please confirm that your company has a Health and Safety Policy signed and dated within the last two years? Do you also have access to competent Health & Safety Advice? If so please provide details including their qualifications If you are successful you must be in a position to provide evidence if required, prior to contract award, and without delay. If you wish you may attach a copy of your Health and Safety Policy.All companies with more than five employees must have a Health and Safety Policy. The buyer may also require you to include a copy of your Health and Safety policy to ensure that you adequately cover your statutory obligations. If your company has fewer than five employees the buyer may also require you to have a Health and Safety Policy. A completed example, and template, can be obtained from the Health and Safety Executive website at: www.hse.gov.uk/risk/health-and-safety-policy-example.doc www.hse.gov.uk/risk/risk-assessment-and-policy-template.doc or by calling 01787 881165 The buyer may require you to confirm that you have reviewed your Health and Safety Policy within the past two years. Failure to provide the adequate information may result in you not being selected to tender. If you are bidding on behalf of a consortium please include data from all consortium members. Only select "Yes" if this applies to all consortium members. Please append a copy of your H&S policy YES/NO33If you use subcontractor(s), or are bidding on behalf of a consortium, do you have processes in place to check whether any of the above circumstances apply to these other organisations?The buyer may not select you to tender if you do not have in place adequate vetting processes to check your subcontractors' record and compliance with Health and Safety legislation. If you are bidding on behalf of a consortium please include data from all consortium members.YES/NO34If your answer to Q33 is yes please provide evidence of the procedures you use to monitor subcontractors' or consortium members' Health and Safety arrangements. This should include any questionnaires used, and details of communication and monitoring methods.The buyer may not select you to tender if you do not have in place adequate vetting processes to check your subcontractors' record and compliance with Health and Safety legislation. If you are bidding on behalf of a consortium please include data from all consortium members.35Please confirm that you have arrangements in place to manage chemicals used under the Control of Substances Hazardous to Health (COSHH) Regulations? If you are successful you must be in a position to provide evidence if required, prior to contract award, and without delay.The buyer may not select a bidding organisation to tender unless it provides evidence of suitable arrangements for the management of chemicals under the COSHH regulations. Failure to do so may mean that you are not selected to tender. If you are bidding on behalf of a consortium please include data from all consortium members. Please append any relevant policy YES/NO36n/an/an/a37You must have a Safeguarding Policy that complies with the Councils policy and provides a commensurable level of protection to be selected to tender. A copy of the Councils policy can be found on the Councils web page.The buyer may not select a bidding organisation to tender if it fails to meet this requirement. If you are bidding on behalf of a consortium please include data from all consortium members. Please append a copy of your safeguarding policy38Please provide the accident statistics relating to your business for the past 3 years. Please report statistics per 100 employees.The buyer may not select you to tender if you do not supply the relevant information Please answer in box below Year - 2015Year - 2016Year - 2017No. of fatal accidents (A)No. of reportable injuries (RIDDOR 1995)(B)No. of employees (full-time equivalents)(C)Incident rate = (A+B) x 100/CNo. of RIDDOR injuries to the publicNo. of RIDDOR dangerous occurrencesNo. of RIDDOR ill-health reports Please confirm that you have signed and uploaded the Certificate of Non-Collusion that can be found in the additional attachments area. The buyer will not select you to tender if you do not sign and upload this document. We will accept an electronic signature on this form.      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