ࡱ> JtGHI# Lbjbjnn dhdh ? TTTTThhhhthCMl`B B B B !#$&L(L(L(L(L(L(L$OeRLLT&!"!&&LLTTB B aL+++&TB TB &L+&&L++6%,+%$%W%W%W%LLLL)W%W%W%CM&&&&RW%W%W%W%W%W%W%W%W% X :  SELF-DECLARATION FORM TENDER FOR OVERMONNOW PRIMARY SCHOOL SEN ALTERATIONS PHASE 2 Guidance to suppliers The purpose of this form is to verify your organisations contact details and to ensure that you are suitably qualified to proceed to award stage. This is a self-certifying form which asks suppliers a series of yes / no questions. Please read all the questions carefully. Be sure to answer every question on this form; incomplete forms cannot be accepted. The form is separated in to two sections, (A & B). The only supporting evidence that you might have to provide when returning this form is in relation to section A. Section A: Supplier Acceptability The questions within this section are subject to either mandatory or discretionary exclusion. If mandatory exclusion applies and you answer yes then you will not progress any further. If discretionary exclusion applies and you answer yes, then the Council may allow you to progress further, but only if you are able to provide sufficient evidence that the circumstances no longer apply. If you are asked to provide further details then you will be required to attach these separately when you return this form. If this is the case then this will be highlighted green. Section B: Supplier Qualification The Council requires you to meet all the requirements within this section. If you do not currently meet a particular requirement then you may be asked to confirm that you are willing to do so prior to contract award. Circumstances where this might apply include Insurance Levels, Dun & Bradstreet registration and Health & Safety. N.B. This is not guaranteed for every procurement exercise; the Council may require you to have these requirements in place already. If this is the case then there will be no question asking you to confirm that you are willing to put them in place. Suppliers do not need to provide supporting documents, for example, accounts, certificates or policies at this stage. Only if you are chosen as the preferred supplier, will the Council ask you to provide evidence and relevant documentation prior to contract award. If you cannot supply the information requested then you will not be awarded the contract and the Council will go to the next preferred supplier. You will be required to provide the documentation within 10 days of receipt of request from the Council. Notes highlighted green explain what documentation will be requested from you if you are chosen as the preferred supplier. If the Council discovers at a later stage that you have falsified any responses on this form your contract will be cancelled. Company Details 1.1Name & address of organisation FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      1.2Registered address: (If different to 1.1) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      1.3Contact name of person applying on behalf of organisation:Position in company: FORMTEXT      Telephone number: FORMTEXT      Fax number: FORMTEXT      Email address: FORMTEXT      Mobile phone number: FORMTEXT      1.4Company Status:Please Indicate Sole TraderYes  FORMCHECKBOX  No  FORMCHECKBOX  PartnershipYes  FORMCHECKBOX  No  FORMCHECKBOX  Limited CompanyYes  FORMCHECKBOX  No  FORMCHECKBOX  Public Limited CompanyYes  FORMCHECKBOX  No  FORMCHECKBOX  CharityYes  FORMCHECKBOX  No  FORMCHECKBOX  Other (please specify) FORMTEXT      Number of employees: (please specify) FORMTEXT      1.6Date of formation or registration: FORMTEXT      1.7Registration number: FORMTEXT      1.8Is your organisation an affiliate or subsidiary of another organisation or holding organisation? If yes, please provide details. Yes  FORMCHECKBOX  No  FORMCHECKBOX 1.9VAT number (if applicable): FORMTEXT       SECTION A - SUPPLIER ACCEPTABILITY Although the Public Contracts Regulations 2015 do not apply in full to contracts valued below the EU thresholds, the Council is adopting Regulation 57(1-7) and (8) for all contracts.. Mandatory Exclusion: If you answer yes to any of the points a) to f) below, the Council is required by law to exclude you from participating further; you will not be selected to tender if any of the grounds for exclusion apply. If any of the grounds for exclusion do apply and you answered yes please attach the details separately when you return this form. The details will be used solely to determine whether the conviction disclosed is one of the types listed in Reg 57 (1-7). If such a conviction exists, your organisation will be automatically excluded. Regulation 57 (1-7) Regulation 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. Please see the following link for further information:  HYPERLINK "http://www.legislation.gov.uk/uksi/2015/102/contents/made" http://www.legislation.gov.uk/uksi/2015/102/contents/made N.B. If any of the mandatory grounds for exclusion become applicable after data has been submitted for a contract, bidders must inform the buyer. Failure to do so may cause any contract awarded to be cancelled.QuestionAnswerHas the bidding organisation or its directors or other people with powers of representation, decision or control been convicted of any of the offences listed above, within Regulation 57 (1-7)?Yes  FORMCHECKBOX  No  FORMCHECKBOX  Discretionary Exclusion: If you answer yes to any of the points below, it is possible that your application will not be accepted. The Council is entitled to exclude you if any of statements below do apply; however, the Council may decide to allow you to proceed further. In the event that any of the following do apply, please attach details separately when you return this form, that will enable the buyer to determine whether the discretionary grounds for exclusion laid out in Regulation 57 (1-7) of the Public Contracts Regulations 2015 apply to you or not. N.B. The Council is entitled to exclude you in the event you are found guilty of serious misrepresentation in providing any information referred to within regulation 57 of the Public Contracts Regulations 2015 or you fail to provide any such information requested by the Council. Regulation 57(8) Regulation 57(8) of the Public Contracts Regulations 2015 sets out grounds on which a services provider may be deemed ineligible to tender for or be awarded a public contract. The bidder being an individual is in a state of bankruptcy or has a receiving order or administration order or bankruptcy restriction order made against him or has made any arrangement for the benefit of creditors. The bidder being a partnership constituted under Scots law has granted a trust deed or become otherwise apparently insolvent, or is subject of a petition presented for sequestration of its estate. The bidder being a company is in the process of winding up, administration, or receivership. The bidding organisation has been convicted of a criminal offence relating to the conduct of its business or profession. The bidding organisation has committed an act of grave misconduct in the course of its business or profession. The bidding organisation has not fulfilled obligations in relation to payment of social security contributions. The bidding organisation has not fulfilled obligations relating to payment of taxes. The bidding organisation is guilty of serious misrepresentations in supplying information required by the Buyer under the Public Contracts Regulations. The bidding organisation is not in possession of a licence or not a member of the appropriate organisation where the law requires it. QuestionAnswerDo any of the circumstances set out in Regulation 57(8) above apply?Yes  FORMCHECKBOX  No  FORMCHECKBOX  Conflict of Interest Discretionary Exclusion: If you answer yes to this question, you will not be able to progress any further with this procurement unless it can be proven that you have taken steps to avoid the perception of a conflict of interest. In the event that you fail to declare a potential conflict of interest the Council may cancel any contract awarded. In the event that a conflict of interest does exist and you answer 'yes' to this question, please attach details separately when you return thisform,to prove that you have taken the necessary steps to avoid perception of a conflict of interest. QuestionAnswerAre 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? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Equal Opportunity & Sustainability Discretionary Exclusion: If you answer yes to the following two questions, you will not be able to progress any further with this procurement unless you are able to provide adequate evidence that you have taken action to prevent similar circumstances from recurring. In the event that any of the statements below do apply, please attach details separately when you return this form. Details should include a summary of the finding or judgment for which you answered yes to and explain what action you have taken to prevent similar circumstances from recurring. Question - Equal OpportunityAnswerHas your organisation had any of the following circumstances applied to them in the last 3 years? a finding of unlawful discrimination by an Employment Tribunal, an Employment Appeal Tribunal or any other court or tribunal (or in comparable proceedings in jurisdiction other than the UK). following formal investigation by the Equality and Human Rights Commission or its predecessors (or a comparable body in a jurisdiction other than the UK), a complaint of unlawful discrimination has been upheld a finding of unlawful discrimination against anyone with protected characteristics has been made against your organisation by any civil or criminal court (or a comparable body in a jurisdiction  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Question - SustainabilityAnswerHas your organisation been convicted or had a notice served upon it for infringement of environmental legislation in the last three years?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  SECTION B SUPPLIER QUALIFICATION QUESTIONS 1.INSURANCE1.1Does your organisation have the following minimum levels of insurance in place? Employers Liability Insurance - 10,000,000.00 Public Liability Insurance - 10,000,000.00 Professional Indemnity Insurance - 5,000,000.00 N.B. If chosen as the preferred supplier you will be required to provide up to date copies of your insurance certificates. Yes  FORMCHECKBOX  No  FORMCHECKBOX 1.1.1If you do not currently have the correct levels of cover in place, are you willing to put them in place if you are chosen as the preferred supplier?Yes  FORMCHECKBOX  No  FORMCHECKBOX 2.ECONOMIC & FINANCIAL STANDING2.1Credit Check Do you have a Dun & Bradstreet D.U.N.S registration number? Please provide your D.U.N.S number here:  FORMTEXT        Yes  FORMCHECKBOX  No  FORMCHECKBOX 2.1.1If you are not currently registered, are you willing to register and supply the Council with your D.U.N.S registration number if you are chosen as the preferred supplier? You can obtain a free D.U.N.S 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 Yes  FORMCHECKBOX  No  FORMCHECKBOX 2.2Acid-test ratio Does your organisation have an acid-test ratio figure of 1 for the last 3 number of financial years? This ratio is defined as: = (Cash + Accounts Receivable + Short Term Investments) divided by (Current Liabilities) Yes  FORMCHECKBOX  No  FORMCHECKBOX 2.3Accounts Please confirm that you will be able to provide accounts for the most recently completed 3 financial years. N.B. If chosen as the preferred supplier you will be required to provide accounts for the last 2 financial years prior to award of contract. 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Yes  FORMCHECKBOX  No  FORMCHECKBOX 4.2If you are not currently accredited and/or compliant with SSIP (or European equivalent) please confirm that you would be willing to register and be assessed by an SSIP member (or European equivalent) if you are chosen as the preferred supplier. N.B. If you are chosen as the preferred supplier you will be required to provide documentation to evidence that you are accredited and/or compliant with an SSIP member (or European equivalent) prior to award of contract. 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