1. Supplier Information [Information Only] 1.1 Supplier details Answer Full name of the Supplier completing the PQQ Registered company address Registered company number Registered charity number Registered VAT number Name of immediate parent company Name of ultimate parent company Please mark ‘X’ in the relevant box to indicate your trading status i) a public limited company ▢ Yes ii) a limited company ▢ Yes iii) a limited liability partnership ▢ Yes iv) other partnership ▢ Yes v) sole trader ▢ Yes vi) other (please specify) ▢ Yes Please mark ‘X’ in the relevant boxes to indicate whether any of the following classifications apply to you i)Voluntary, Community and Social Enterprise (VCSE) ▢ Yes ii) Small or Medium Enterprise (SME) ▢ Yes iii) Sheltered workshop ▢ Yes iv) Public service mutual ▢ Yes 1.2 Bidding model
7. Environmental [Scored: 20 points] The Authority has adopted a positive position with regard to environmental, sustainable and ethical actions, therefore: 7.1 Please provide details of any environmental or sustainable procedures and processes you have implemented, i.e. ISO 14001 or equivalent - Please provide copies of certification using template and referencing 7.2 What percentage of waste to do you recycle as an organisation across all activities? 7.3 What percentage of your goods and materials are procured from an ethical and sustainable source? 7.4 Do you have an example of an initiative adopted by your organisation that has either reduced co2 emissions, fuel or energy usage, or has reduced the environmental impact of its activities? 8. Health & Safety [Scored: 20 points] All organisations are required to comply with the duties imposed upon them by the Health and Safety at Work etc. Act 1974 and subordinate legislation, and in particular, the duty of care not only to their own employees but also to people other than their own employees including representatives of the Authority and all members of the public 8.1 Please provide the name and position of person with overall responsibility for the implementation of your organisation’s safety policy 8.2 Please evidence that you have a Health & Safety Policy/Management System. If large please supply a copy of the index with the following extracts, signed policy statement, accident reporting, risk assessment and training etc, (completing the template appendix)n 8.3 Please provide details of the health and safety training provided by your organisation to employees (completing template appendix)
11.1 In order to show proof of competence in supplying this service to other Housing Associations, Local Authorities or Private Companies you are required to provide two written references. There is a Confidential Reference form attached (Annex B) that you the Supplier are responsible for sending to your referees. It is imperative that completed Reference forms are received by the PQQ closing date. Failure to provide references will affect your score. 12. Maximum score possible: 150 13. Additional PQQ modules Suppliers who self-certify that they meet the requirements for these additional modules will be required to provide evidence of this if they are successful at contract award stage. Please indicate your answer by marking ‘X’ in the relevant boxes. A - Insurance 1. 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 below: Employer’s Liability Insurance = £10,000,000 Public Liability Insurance = £10,000,000 Professional Indemnity (Design only) Insurance = £5,000,000 Product Liability Insurance = £5,000,000 ▢ Yes ▢ No