2A.5.6 Postal address Country: [text] 2A.6 Contact person or persons: [text] 2A.7 Telephone (including dialling code): [number] 2A.8 Mobile (including dialling code): [number] 2A.9 Email: [number] 2A.10 Internet address (web address) (if applicable): [text] 2A.11 Name of parent company (if applicable): [text] 2A.12 Name of ultimate parent company (if applicable): [text] 2A.13 Bidder Legal Status: Sole Trader Private Limited Company Public Limited Company Partnership Other 2A.13.1 If you have answered 'Other' to the above question please provide details here: [text] Question Reference Identification Answer 2A.14 Please confirm the size of your organisation: [] Micro [] Small [] Medium [] Large 2A.15 Is your organisation a supported business or will it provide for the performance of the contract in the context of supported employment programmes? [] Yes [] No 2A.15.1 If you have answered yes to the previous question, what is the corresponding percentage of disabled or disadvantaged workers? [number] 2A.15.2 If you have answered yes to question 2A.15, please specify [text]
3B.1.7 d) Has the bidder fulfilled or will it fulfil its obligations by paying or entering into a binding arrangement with a view to paying the taxes or social security contributions due, including, where applicable, any interest accrued or fines? [] Yes [] No If yes, please provide details: [text] [] Yes [] No If yes, please provide details: [text] 3B.1.8 If the relevant documentation concerning payment of taxes or social contributions is available electronically, please indicate: Web address: [text] Issuing authority or body: [text] Precise reference of the documentation: [text] C: Question Reference Information concerning possible blacklisting Answer 3C.1 Has the bidder committed an act prohibited under the Employment Relations Act 1999 (Blacklists) Regulations 2010? [] Yes [] No 3C.1.1 If yes, when did the breach occur? [text] 3C.1.2 If yes, please give details about the breach: [text] 3C.1.3 If yes, has this been established by a judicial decision having final and binding effect? [text] 3C.1.4 If yes, has the bidder taken measures to demonstrate its reliability despite the existence of this ground for exclusion [] Yes [] No 3C.1.5 If yes, please describe the measures taken: [text]
D: Instructions for Bidders Please note that, for the purpose of this procurement, some of the following exclusion grounds may have been defined more precisely, in national law, in the relevant Contract Notice. For further information please refer to Regulation 58 (8) of the for above OJEU procurements and Regulation 9 of The for below OJEU procurements. Question Reference Information concerning environmental, social and labour law Answer 3D.1 Has the bidder, to its knowledge, breached its obligations in the fields of environmental law? [] Yes [] No 3D.1.1 If yes, when did the breach occur? [text] 3D.1.2 If yes, please give details about the breach: [text] 3D.1.3 If yes, has the bidder taken measures to demonstrate its reliability despite the existence of this ground for exclusion (“Self-Cleansing”)? [] Yes [] No 3D.1.4 If it has, please describe the measures taken: [text] 3D.2 Has the bidder, to its knowledge, breached its obligations in the fields of social law? [] Yes [] No 3D.2.1 If yes, when did the breach occur? [text] 3D.2.2 If yes, please give details about the breach: [text] 3D.2.3 If yes, has the bidder taken measures to demonstrate its reliability despite the existence of this ground for exclusion (“Self-Cleansing”)? [] Yes [] No 3D.2.4 If it has, please describe the measures taken: [text] 3D.3 Has the bidder, to its knowledge, breached its obligations in the fields of labour law? [] Yes [] No 3D.3.1 If yes, when did the breach occur? [text] 3D.3.2 If yes, please give details about the breach: [text] 3D.3.3 If yes, has the bidder taken measures to demonstrate its reliability despite the existence of this ground for exclusion (“Self-Cleansing”)? [] Yes [] No 3D.3.4 If it has, please describe the measures taken: [text]
3D.11.1 If yes, please provide details: [text] 3D.11.2 If yes, has the bidder taken self-cleansing measures? [] Yes [] No 3D.11.3 If it has, please describe the measures taken: [text] 3D.12 Is the bidder aware of any conflict of interest due to its participation in the procurement procedure? [] Yes [] No 3D.12.1 If yes, please provide details: [text] 3D.13 Has the bidder or an undertaking related to it advised the organisation or contracting entity or otherwise been involved in the preparation of the procurement procedure? [] Yes [] No 3D.13.1 If yes, please provide details: [text] Question Reference Early termination Answer 3D.14 Has the bidder experienced that a prior public contract, a prior contract with a contracting entity or a prior concession contract was terminated early, or that damages or other comparable sanctions were imposed in connection with that prior contract? [] Yes [] No 3D.14.1 If yes, please provide details: [text] 3D.14.2 If yes, has the bidder taken self-cleansing measures? [] Yes [] No 3D.14.3 If it has, please describe the measures taken: [text] Question Reference Misrepresentation Answer 3D.15.1 Can the bidder confirm that: a) It has not been guilty of serious misrepresentation in supplying the information required for the verification of the absence of grounds for exclusion or the fulfilment of the selection criteria, [] Yes [] No 3D.15..2 b) It has not withheld such information, [] Yes [] No 3D.15.3 c) It has been able, without delay, to submit the supporting documents required by an organisation or contracting entity, and [] Yes [] No
systems used: 4C.5 5) For complex products or services to be supplied or, exceptionally, for products or services which are required for a special purpose: Will the bidder will allow checks by the public body or any competent official body from their country, to be conducted on the production capacities or the technical capacity of the bidder and, where necessary, on the means of study and research which are available to it and on the quality control measures? [] Yes [] No 4C.6 6) The following educational and professional qualifications are held by: a) The service provider or the contractor itself: [text] 4C.6.1 and/or (depending on the requirements set out in the relevant Contract Notice) b) Its managerial staff: [text] 4C.7 7) Please provide details of the environmental management measures which the bidder will be able to use when performing the contract: [text] 4C.8 8a) Please provide details of the average annual manpower for the last three years: Year, average annual manpower: Year 1: [Year],[number], Year 2: [Year],[number], Year 3: [Year],[number]. 4C.8.1 8b) Please provide details of the number of managerial staff for the last three years: Year, number of managerial staff: Year 1: [Year],[number], Year 2: [Year],[number], Year 3: [Year],[number]. 4C.9 9) Please provide details of [text]
relevant tools, plant or technical equipment available to you in relation to this procurement exercise: 4C.10 10) Please provide details of theproportion (i.e. percentage) of the contract that you intend to subcontract: [text] 4C.11 11a) For public supply contracts the bidder will supply the required samples, descriptions or photographs of the products to be supplied, which do not need to be accompanied by certifications of authenticity: [] Yes [] No 4C.11.1 11b) Where applicable, the bidder furthermore declares that it will provide the required certificates of authenticity: [] Yes [] No 4C.11.2 11c) If the relevant documentation is available electronically, please indicate: Web address: [text] Issuing authority or body: [text] Precise reference of the documentation: [text] 4C.12 12) For public supply contracts: Can the bidder provide the required certificates drawn up by official quality control institutes or agencies of recognised competence attesting the conformity of products clearly identified by references to the technical specifications or standards, which are set out in the relevant Contract Notice? [] Yes [] No 4C.12.1 If not, please explain why and state which other means of proof can be provided: [text] 4C.12.2 If the relevant documentation is available electronically, please indicate: Web address: [text] Issuing authority or body: [text] Precise reference of the documentation: [text]