The authority recognises that arrangements set out in section 1.2 of the standard Selection Questionnaire, in relation to a group of economic operators (for example, a consortium) and/or use of sub-contractors, may be subject to change and will, therefore, not be finalised until a later date. The lead contact should notify the authority immediately of any change in the proposed arrangements and ensure a completed Part 1 and Part 2 is submitted for any new organisation relied on to meet the selection criteria. The authority will make a revised assessment of the submission based on the updated information. For Part 1 and Part 2 every organisation that is being relied on to meet the selection must complete and submit the self-declaration. All sub-contractors are required to complete Part 1 and Part 2. For answers to Part 3 - If you are bidding on behalf of a group, for example, a consortium, or you intend to use sub-contractors, you should complete all of the questions on behalf of the consortium and/ or any sub-contractors, providing one composite response and declaration. The authority confirms that it will keep confidential and will not disclose to any third parties any information obtained from a named customer contact, other than to the Cabinet Office and/or contracting authorities defined by the regulations, or pursuant to an order of the court or demand made by any competent authority or body where the authority is under a legal or regulatory obligation to make such a disclosure. Part 1: Potential supplier Information Please answer the following questions in full. Note that organisation that is being relied on to meet the selection must complete and submit the Part 1 and Part 2 self-declaration. Section 1 Potential supplier information Question number Question Response 1.1(a) Full name of the potential supplier submitting the information 1.1(b) – (i) Registered office address (if applicable) 1.1(b) – (ii) Registered website address (if applicable) 1.1(c) Trading status public limited company limited company limited liability partnership other partnership sole trader third sector other (please specify your trading status) 1.1(d) Date of registration in country of origin 1.1(e) Company registration number (if applicable) 1.1(f) Charity registration number (if applicable) 1.1(g) Head office DUNS number (if applicable)
- Head office VAT number (if applicable) (Please enter N/A if not applicable) 1.1(p) Details of ultimate parent company: - Full name of the ultimate parent company - Registered office address (if applicable) - Registration number (if applicable) - Head office DUNS number (if applicable) - Head office VAT number (if applicable) (Please enter N/A if not applicable) Please note: A criminal record check for relevant convictions may be undertaken for the preferred suppliers and the persons of significant in control of them. Please provide the following information about your approach to this procurement: Section 1 Bidding Question number Question Response 1.2(a) - (i) Are you bidding as the lead contact for a group of economic operators? Yes ☐ No ☐ If yes, please provide details listed in questions 1.2(a) (ii), (a) (iii) and to 1.2(b) (i), (b) (ii), 1.3, Section 2 and 3. If no, and you are a supporting bidder please provide the name of your group at 1.2(a) (ii) for reference purposes, and complete 1.3, Section 2 and 3. 1.2(a) - (ii) Name of group of economic operators (if applicable) 1.2(a) - (iii) Proposed legal structure if the group of economic operators intends to form a named single legal entity prior to signing a contract, if awarded. If you do not propose to form a single legal entity, please explain the legal structure. 1.2(b) - (i) Are you or, if applicable, the group of economic operators proposing to use sub-contractors? Yes ☐ No ☐ 1.2(b) - (ii) If you responded yes to 1.2(b)-(i) please provide additional details for each in the following table: we may ask them to complete this form as well.
3.1(j) –(iii) 3.1(j)-(iv) The organisation is not able to submit supporting documents required under regulation 59 of the Public Contracts Regulations 2015. The organisation has influenced the decision-making process of the contracting authority to obtain confidential information that may confer upon the organisation undue advantages in the procurement procedure, or to negligently provided misleading information that may have a material influence on decisions concerning exclusion, selection or award. Yes ☐ No ☐ If Yes please provide details at 3.2 Yes ☐ No ☐ If Yes please provide details at 3.2 3.2 If you have answered Yes to any of the explain what measures been taken to demonstrate the reliability of the organisation despite the existence of a relevant ground for exclusion? (Self Cleaning) Part 3: Selection Questions Section 4 Economic and Financial Standing Question Response 4.1 Are you able to provide a copy of your audited accounts for the last two years, if requested? If no, can you provide one of the following: answer with Y/N in the relevant box. Yes ☐ No ☐ (a) A statement of the turnover, Profit and Loss Account/Income Statement, Balance Sheet/Statement of Financial Position and Statement of Cash Flow for the most recent year of trading for this organisation. Yes ☐ No ☐ (b) A statement of the cash flow forecast for the current year and a bank letter outlining the current cash and credit position. Yes ☐ No ☐ (c) Alternative of demonstrating financial status if any of the above are not available (e.g. forecast of turnover for the current year and a statement of funding provided by the owners and/or the bank, charity accruals accounts or an alternative means of demonstrating financial status). Yes ☐ No ☐
4.2 Where we have specified a minimum level of economic and financial standing and/ or a minimum financial threshold within the evaluation criteria for this procurement, please self-certify by answering ‘Yes’ or ‘No’ that you meet the requirements set out. Yes ☐ No ☐ Section 5 If you have indicated in the Selection Questionnaire question 1.2 that you are part of a group, please provide further details below: Name of organisation Relationship to the Supplier completing these questions 5.1 Are you able to provide parent company accounts if requested to at a later stage? Yes ☐ No ☐ 5.2 If yes, the parent company be willing to provide a guarantee if necessary? Yes ☐ No ☐ 5.3 If no, would you be able to obtain a guarantee elsewhere (e.g. from a bank)? Yes ☐ No ☐ Section 6 Technical and Professional Ability 6.1 Relevant experience and contract examples Please provide details of up to contracts, in any combination from either the public or private sector; voluntary, charity or social enterprise (VCSE) that are relevant to our requirement. VCSEs may include samples of grant-funded work. Contracts for supplies or services should have been performed during the past three years. Works contracts may be from the past five years. The named contact provided should be able to provide written evidence to confirm the accuracy of the information provided below. Consortia bids should provide relevant examples of where the consortium has delivered similar requirements. If this is not possible (e.g. the consortium is newly formed or a Special Purpose Vehicle is to be created for this contract) then three separate examples should be provided between the principal member(s) of the proposed consortium or Special Purpose Vehicle (three examples are not required from each member). Where the Supplier is a Special Purpose Vehicle, or a managing agent not intending to be the main provider of the supplies or services, the information requested should be provided in respect of the main intended provider(s) or who will deliver the contract. If you cannot provide examples see question 6.3
Section 7 Modern Slavery Act 2015: Requirements under Modern Slavery Act 2015 7.1 Are you a relevant commercial organisation as defined by section 54 ("Transparency in supply chains etc.") of the Modern Slavery Act 2015 ("the Act")? Yes ☐ N/A ☐ 7.2 If you have answered yes to question 7.1 are you compliant with the annual reporting requirements contained within Section 54 of the Act 2015? Yes ☐ Please provide the relevant url … No ☐ Please provide an explanation 8. Additional Questions Suppliers who self-certify that they meet the requirements to additional questions will be required to provide evidence of this if they are successful at contract award stage. Section 8 Additional Questions 8.1 Insurance a. 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: Y/N Employer’s (Compulsory) Liability Insurance = £5 million Public Liability Insurance = £1 million Professional Indemnity Insurance = £1 million Product Liability Insurance = £x *It is a legal requirement that all companies hold Employer’s (Compulsory) Liability Insurance of £5 million as a minimum. Please note this requirement is not applicable to Sole Traders.