Service Lot Number Application made to this Service Lot Application made to this Sub-Category Service Lot 1 – Engagement (a) Black Country Wide (all areas) (b) Dudley (c) Sandwell (d) Walsall (e) Wolverhampton Service Lot 2 – Specialist Support (a) Country Wide (all areas) (b) Dudley (c) Sandwell (d) Walsall (e) Wolverhampton Service Lot 3 – Skills for Life and Life Skills (a) Black Country Wide (all areas) (b) Dudley (c) Sandwell (d) Walsall (e) Wolverhampton Service Lot 4 – Employability and Work Skills (a) Country Wide (all areas)
3.1(a) Breach of environmental obligations? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(b) Breach of social obligations? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(c) Breach of labour law obligations? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(d) Bankrupt or is the subject of insolvency or winding-up proceedings, where the organisation’s assets are being administered by a liquidator or by the court, where it is in an arrangement with creditors, where its business activities are suspended or it is in any analogous situation arising from a similar procedure under the laws and regulations of any State? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(e) Guilty of professional misconduct? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(f) Entered into agreements with other economic operators aimed at distorting competition? Yes ☐ No ☐ If yes, please provide
details at 3.2 3.1(g) Aware of any conflict of interest within the meaning of Regulation 24 of the Public Contracts Regulations 2015 due to the participation in the procurement procedure? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(h) Been involved in the preparation of the procurement procedure? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(i) Shown significant or persistent deficiencies in the performance of a substantive requirement under a prior public contract, a prior contract with a contracting entity, or a prior concession contract, which led to early termination of that prior contract, damages or other comparable sanctions? Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(j) Please answer the following statements: 3.1(j) – (i) The organisation is 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 ☐ If yes, please provide details at 3.2 3.1(j) – (ii) The organisation has withheld such information. Yes ☐ No ☐ If yes, please provide details at 3.2 3.1(j) – (iii) The organisation is not able to submit supporting documents required under Yes ☐
You may fail question C1 if you are a relevant commercial organisation and you are unable: (i) to give the confirmation requested in question C1.2 above; or (ii) to explain to the Impact Partnership's satisfaction what steps you are taking in relation to those reporting requirements. Question C2 – Compliance with equality legislation (pass/fail) For organisations working outside of the UK please refer to equivalent legislation in the country that you are located Question number Question Response C2.1 In 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)? ☐ Yes ☐ No C2.2 In the last three years, 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? ☐ Yes ☐ No If you have answered “yes” to one or both of the questions above, please provide, as a separate Appendix, a summary of the nature of the investigation and an explanation of the outcome of the investigation to date. If the investigation upheld the complaint against your organisation, please use the Appendix to explain what action (if any) you have taken to prevent unlawful discrimination from reoccurring. C2.3 If you use sub-contractors, do you have processes in place to check whether any of the above circumstances apply to these other organisations? ☐ Yes ☐ No