ࡱ> ^a[\]{ ;YbjbjBrBr 4`  1FTzz8 4A!!(0!0!0! "\g&'???????$DPG^@q( " "((@0!0!xA%+%+%+(v0!0!?%+(?%+%+y=>0!.=)>?A0A1>G[*G(>G>%+(((@@%+(((A((((G(((((((((z : Selection Questionnaire This questionnaire tells the Council about your firm or organisation and the kinds of business that you would like an opportunity to tender for. The Council wishes in particular to create wider opportunities for small and micro local enterprises and voluntary and community sector organizations to do business with it. The Council hopes that local firms and organizations will use this questionnaire to express their interest in participating in its work. Your objective in completing this questionnaire is to demonstrate that you: are technically and professionally capable of meeting the Councils needs are able to commit the staff and resources needed to perform contracts successfully are sound financially, and have in place the insurance cover, policies, procedures and business practices required by the Council. The information you give will be used to help the Council decide which firms and organizations are going to the next stage. To minimise the amount of paperwork needed from you, the Council does not require you to provide supporting documents  for example, accounts, certificates, statements or policies with this form. The Council may, however, ask to see these documents at a later stage, so it is advisable you make sure they can be made available on request. You may also be asked later to clarify your answers or provide more details about certain points. The information you supply in this questionnaire will be treated in confidence and in compliance with the Data Protection Act 1998. Your information will not be shared with any third party. Please answer every question, and pay attention to the Councils wording about the information to be supplied. Answers to Sections A (Corporate Data) are for information only and will not be scored. Section B (Financial Data) will be scored on a Pass/Fail basis. Sections C (Technical Capability) and D (Business Approach) will be scored. If you believe that a question does not apply to you, please write N/A or Not Applicable. If you do not know the answer to a question, please explain why. Some questions have word limits on responses, e.g. maximum 100 words. In drafting your response, focus initially on the essential points, then prune the text down to fit within the word limits. Using bullet points can save words. Section A: CORPORATE DATA BASIC DETAILS OF YOUR FIRM OR ORGANISATIONThe trading name of the firm or organisation seeking to contract with the CouncilContact person for enquiries about this form: please state name and job title/post) Address for correspondence (with post code) Registered office address (if different from above) Addresses of other offices (if applicable)Phone number of person named in 1.2Fax number of person named in 1.2E-mail address (if available) of person named in 1.2Website of firm or organisation (if any)Legal status of organisation Please tick as appropriate. Sole trader c Public limited company c Private limited company c Limited partnership c Limited liability partnership c Social enterprise c Cooperative c Registered charity c Voluntary, community interest or faith sector organization c Other (please specify) c Company registration number and date (if registered at Companies House)Charity Commission or other registration number (if applicable) VAT registration number (if applicable) If your organization is part of a Group, please state the name and Companies House registration number of the parent company.Are you acting as the lead organisation for a consortium?Yes c No cIf you answered Yes to 1.14, please list the members of your consortium. How many staff does your organisation have in total? Include part-time staff and volunteers.What types of works, services or supplies are you interested in tendering for?  Y MANAGEMENT 2.1Please list the full names of the proprietors, directors, partners or trustees of your organization. 2.2List here the names of any of the above who are or have been employed by Leicester City Council or Councillors of Leicester City Council or who have a relative, partner or associate who is employed by the Council at a senior level or who is a Councillor, or who have any involvement in other organisations that provide services to the Council.  Business Probity Regulation 23 of the Public Contracts Regulations 2006 enables public sector authorities to exclude and disqualify organisations from tendering in the following circumstances: If an organisation that is a company: has had a winding-up order has gone into administration or is the subject of related legal proceedings has failed to meet its tax or social security obligations has court actions or industrial tribunal hearings outstanding against it has ever had to pay liquidated or unliquidated damages levied in respect of a failure to perform to the terms of a contract. If any of the Directors, Partners, Associates or the Company Secretary has been involved in any organisation that has been liquidated or gone into receivership has been convicted of a criminal offence relating to conspiracy, corruption, bribery, fraud, theft and/or money laundering or to the conduct of their business or profession has committed an act of grave misconduct in the course of their business or profession. If the tenderer is an individual and is bankrupt or has been declared insolvent or has had a receiving order or administration order made against them. 3BUSINESS PROBITY3.1Do you confirm that your organization to the best of your knowledge is not liable to exclusion from tendering on any of the grounds listed above?Yes c No c Section B: FINANCIAL DATA 4FINANCIAL INFORMATION 4.1Please state your total turnover in each of the last two financial years (if you are leading a consortium please state its aggregated turnover). Note: The Council normally requires a firm or organisation to have a level of annual turnover that is at least twice the estimated value of the contract for which the firm or organization is seeking to tender. for year ended --/--/-- for year ended --/--/--4.2Please indicate which of the following documents you would you be able to provide. At least one financial document is required.A copy of your audited accounts for the two most recent years of trading (if applicable)A statement of your turnover, profit & loss account and cash flow for the most recent year of tradingA statement of your cash flow forecast for the current year and a letter from your bank outlining your current cash and credit positionAlternative means of demonstrating your financial status if you have been trading for less than a year4.3If requested, would you be able to provide a bankers reference?Yes c No c4.4Has your organisation met the terms of its banking facilities and loan agreements (if any) during the past year?Yes c No c4.5Has your organisation met all its obligations to pay its creditors and staff during the past year?Yes c No c 5Y INSURANCE 5.1 Please indicate the levels of insurance cover that you hold: Public liability Employers liability Professional Indemnity (if applicable) Cover for working with, removal and disposal of asbestos-containing materials (if applicable) Product liability (if applicable)  The council expects a minimum level of 10million for Public Liability, 10million for Employers Liability and 5million for Professional Indemnity. If you do not have the sufficient levels, please tick this box if you are willing to get the required minimum standards prior to award. c Section C: TECHNICAL CAPABILITY 6ACTIVITIES & STAFF RESOURCES 6.1Please refer to the speadsheet attached with this advert. 7EXPERIENCE AND REFERENCE CONTRACTS7.1Please summarise your experience within the past 3 (three) years of undertaking contracts similar to those for which you wish to tender, including contracts for local authority clients, other public sector bodies, voluntary organisations, community groups and private sector organisations. (maximum 150 words)7.2Please provide brief details of 3 (three) significant private or public sector contracts which your organisation has performed within the past 2 (two) years. Contract 1Contract 2Contract 37.3Client/customer organisation (name) Website (if available)7.4Customer contact name, phone number and email * 7.5Date contract awarded7.6Date contract completed7.7Brief description of contract (maximum 100 words)  7.8Contract value7.9If you cannot provide information on at least one reference contract, please briefly explain why (maximum 100 words) Note: The customer contact should be prepared to speak to the Council, if required, in order to confirm the accuracy of the information provided here. Section D: BUSINESS APPROACH 8QUALITY ASSURANCE8.1Does your organisation apply documented quality management procedures? Yes c No c8.2Does your organisation hold a recognised quality management accreditation, for example ISO 9001 or equivalent? Yes c No c8.3Does your organisation have specific procedures to ensure effective communication with your clients and customers?Yes c No c8.4Can you confirm that your organization has never failed to complete a contract or had it terminated by a client? Yes c No c Health & Safety Any organisation employing five or more people has by law to prepare and bring to the attention of employees a written Health and Safety Policy Statement. A Heath and Safety Policy usually has three distinct sections namely: General Policy Statement a short statement outlining the organisations commitment to health and safety, signed and dated by the senior organisation official (for example the Managing Director) Organisation how the organisation addresses health and safety; lines of communication between managers and staff; and any specific duties/responsibilities assigned within the organisation this should be relatively straightforward for small organisations. Arrangements the systems and procedures in place for ensuring employees health and safety at work. System means processes and procedures to ensure that health and safety is properly managed and that legal requirements are met. The Council may request that you provide at short notice a copy of your Health and Safety Policy, any codes of safe working practices issued to employees, and/or risk assessments. You should have these documents readily available. 9HEALTH & SAFETY9.1Does your organisation have a health and safety policy supported by documented health and safety procedures? Yes c No c9.2Does your organisation either have a person on the staff qualified in health and safety or have access to competent advice from an external health and safety specialist?Yes c No c9.3Is your organisation a member of a recognised health and safety accreditation scheme such as CHAS (Contractors Health and Safety Assessment Scheme)Yes c No c9.4Can you confirm that your organisation has not been prosecuted under any relevant health and safety legislation within the last five years?Yes c No c 10EQUALITY 10.1Does your organisation apply written procedures ensuring compliance with equality and anti-discrimination legislation? Yes c No c10.2Can you confirm that in the last three years no finding of unlawful discrimination has been made against your organisation by any court or industrial or employment tribunal or equivalent body? Yes c No c10.3Can you confirm that in the last three years your organisation has not been the subject of a formal investigation by the Equality and Human Rights Commission or an equivalent body on grounds of alleged unlawful discrimination? Yes c No c10.4If we asked, could you provide examples of your organisation s instructions, documents, recruitment advertisements or other literature in which you declare a commitment to equality and diversity?Yes c No c 11TRAINING 11.1Does your organisation maintain a structured programme of training and professional development for your staff throughout their employment ? Yes c No c11.2Do you arrange personalised training to reflect job specifications, roles and responsibilities? Yes c No c 12ENVIRONMENTAL MANAGEMENT 12.1Does your organisation apply documented environmental management procedures aimed at the reduction of energy consumption, carbon footprint and waste, and the promotion of recycling? 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Yes c No c13.2Does your organisation have experience of promoting opportunities for local enterprises to join a supply chain as suppliers or sub-contractors?Yes c No c 14BUSINESS CONTINUITY 14.1Does your organisation have in place measures that will enable you to maintain your business activities in the event of an emergency situation or unforeseen event? Yes c No c 15SAFEGUARDING 15.1Do the activities of your organisation involve procedures for child protection and/or the safeguarding of vulnerable adults? Yes c No c 16DATA PROTECTION 16.1Does your organisation apply procedures for the protection of personal information about individuals in conformity with the Data Protection Act 1998? Yes c No c DECLARATION I declare that to the best of my knowledge the answers submitted in this form are correct. I understand that the information will be used only to assess my organisations suitability to be invited to tender for the Councils requirements. I understand that the Council may reject this form if there is a failure to answer all relevant questions fully or if I provide false or misleading information. FORM COMPLETED BYName:Position (Job Title):Date:Phone number:Signature: (please type your name or provide an electronic signature)Proposed scoring of Selection Questionnaire 1 Basic Details of Organisation 1.1 to 1.17 not scored; for information only, but must be answered in full. Failure to provide any item of information will be considered non-compliant and the applicant may not be considered further in the evaluation. 2 Management 2.1-2.2 pass/fail; fail if list requested in 2.1 is not attached, if information requested in 2.2 is not provided, or if the answer to 2.2 indicates a potential conflict of interest 3 Business probity 3.1 pass/fail; fail if answer is NO 4 Financial information 4.1-4.5 pass/fail; fail if information not provided or answer to 4.3, 4.4 or 4.5 is NO. 5 Insurance 5.1 pass/fail; fail If the contractor does not have the minimum level of insurance cover or cannot provide it for any of the applicable insurances 6 Activities and staff resources 6.1 Please check the attached spreadsheet. 7. Experience and reference contracts 7.1-7.8 overall AssessmentScoreInterpretationGood4Satisfies the requirement with minor additional benefits. Above average demonstration by the Bidder of the relevant ability, understanding, experience, skills, resource & quality measures required to provide the supplies / services. Response identifies factors that will offer potential added value, with evidence to support the response.Acceptable3Satisfies the requirement. Demonstration by the Bidder of the relevant ability, understanding, experience, skills, and resource & quality measures required to provide the supplies / services, with evidence to support the response.Minor Reservations2Satisfies the requirement with minor reservations. Some minor reservations of the Bidders relevant ability, understanding, experience, skills, and resource & quality measures required to provide the supplies / services, with little or no evidence to support the response.Serious Reservations1Satisfies the requirement with major reservations. Considerable reservations of the Bidders relevant ability, understanding, experience, skills, and resource & quality measures required to provide the supplies / services, with little or no evidence to support the response.Unacceptable0Does not meet the requirement. 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TX`A`ALbP  TT`A`ALbP    TT_f`A`A_LbP    T@_`A`A_SLbThe Council wishes in particular to create wider opportunities for small and micro                       T8_`A`A_RLblocal enterprises and voluntary and community sector organizations to do business                       T_]`A`A_LLbwith it. The Council hopes that local firms and organizations will use this                    T_&`A`A_ELbquestionnaire to express their interest in participating in its work.                  TT'.`A`A'LbP  Rp@"Arial&L($`m1L( @%0(%= w1@%L( , w1`3. * Arialp%8Dp1߬%jmn1%b2%,Pdv% % % % % %   TT_f`A`A_&" WMFC @B@LbP   % % %  T_`A`A_ LbYour objective in completin         TxI`A`A Lb\g this   TJ`A`AJ  Lbhquestionnaire    TT`A`A LbP  Tg`A`A Lbis to demonstrate that you:      TTho`A`Ah LbP  Rp@Symbol&h(h %`m1h( \%L(%= w1\%h( < w1`5Symbol%8Dp1%jmn1%b2%<`dv% % % % % % % % %  % % %  TT_e*`A`A_'LbP% % %  TTfv)`A`Af'LbP % % %  Tdw*`A`Aw'LbTare   TH*`A`A'*Lbtechnically and professionally capable of             Tx*`A`A'Lb\meeting   TT*`A`A'LbP b T?*`A`A' Lbdthe Council   TX@K*`A`A@'LbP s TTLO*`A`AL'LbP  TlP{*`A`AP'LbXneeds  TT|*`A`A|'LbP   % % %  TT_*e<`A`A_9LbP% % %  TTf+v;`A`Af9LbP % % %  Tdw+<`A`Aw9LbTare   T+<`A`A9Lblable to commit      T`+<`A`A9LbTthe  TT+<`A`A9LbP b T+<`A`A9Lbtstaff and resources      Tx+<`A`A9Lb\needed   T+a<`A`A9Lbtto perform contract      Tb+<`A`Ab9Lbhs successfully    TT+<`A`A9LbP  TT+<`A`A9LbP   % % %  TT_;eM`A`A_JLbP% % %  TTf<vL`A`AfJLbP % % %  Tdw<M`A`AwJLbTare   T<*M`A`AJLbxsound financially, and     TT+<2M`A`A+JLbP   % % %  TT_Me_`A`A_\LbP% % %  TTfNv^`A`Af\LbP % % %  TwN_`A`Aw\Lbxhave in place the ins        TN_`A`A\:Lburance cover, policies, procedures and business practices                  Tw_p`A`AwmLb|required by the Council.      TT_&p`A`AmLbP    TT_pf`A`A_~LbP    T_7`A`A_CLbThe information you give will be used to help the Council decide wh                     T8`A`A8Lbhich firms and       TD_}`A`A_)Lborganizations are going to the next stage            TT~`A`A~L&" WMFC @"@bP. TT`A`ALbP  TT`A`ALbP   % % %  TT_f`A`A_LbP   % % %  TX_q`A`A_LbPTo  TTrt`A`ArLbP  TPu`A`Au+Lbminimise the amount of paperwork needed fro             T<`A`A(Lbm you, the Council does not require you            T _L`A`A_ Lbto provide supporting documents          TTMT`A`AMLbP  TTUX`A`AULbP  TY`A`AY3Lbfor example, accounts, certificates, statements or           Rp @ Arial|m1|Zw1@w1`m1 = w1 2d 3. Arialdv% % % % %  % % %  T_`A`A_ Lb`policies   TT`A`ALbP  TT`A`ALbP  T `A`ALblwith this form.     % % %  TX `A`A LbP % % %  T`A`A:LbThe Council may, however, ask to see these documents at a             T_`A`A_ Lbdlater stage   T`A`A!Lb, so it is advisable you make sur         T\`A`A-Lbe they can be made available on request. You               TP_`A`A_VLbmay also be asked later to clarify your answers or provide more details about certain                      T|_`A`A_Lb\points.   TT`A`ALbP   % % %  TT_f*`A`A_(LbP   % % %  T _*R;`A`A_8#LbThe information you supply in this          TS*;`A`AS8Lbhquestionnaire    T,*;`A`A8%Lbwill be treated in confidence and in             T_:0K`A`A_HLbcompliance with the Data Prot          T1:K`A`A1H:Lbection Act 1998. Your information will not be shared with                  T_K\`A`A_YLblany third party.     TTK\`A`AYLbP   % % %  TT_]fm`A`A_kLbP   % % %  T_m'~`A`A_{ALbPlease answer every question, and pay attention to the Council s              &" WMFC @@   Tx(m`~`A`A({Lb\wording    TTamd~`A`Aa{LbP  Tem~`A`Ae{ Lb`about the      T_~`A`A_Lbinformation to be supplied         TT~`A`ALbP. TT~#`A`ALbP    TT_f`A`A_LbP    T_@`A`A_DLbAnswers to Sections A (Corporate Data) are for information only and                   TA`A`AA Lbdwill not be      TD_`A`A_TLbscored. Section B (Financial Data) will be scored on a Pass/Fail basis. Sections C                        T_$`A`A_@Lb(Technical Capability) and D (Business Approach) will be scored.                 TT%,`A`A%LbP    TT_f`A`A_LbP    T _p`A`A_NLbIf you believe that a question does not apply to you, please write N/A or Not                        T_`A`A_LblApplicable. If y    Tw`A`A=Lbou do not know the answer to a question, please explain why.                  TTx`A`AxLbP    TT_f`A`A_LbP    TD_'`A`A_$TLbSome questions have word limits on responses, e.g.  maximum 100 words . In drafting                        T\_&7`A`A_4XLbyour response, focus initially on the essential points, then prune the text down to fit                        T_7H`A`A_ELbxwithin the word limit        T07H`A`AE&Lbs. Using bullet points can save words.           TT7H`A`AELbP    TT_HfY`A`A_VLbP  Rp @"Arial&L($`m1L( @%0(%= w1@%L( L w1`3. * Arialp%8Dp1߬%jmn1%b2%Lpdv% % % % % %   TT_Yfj`A`A_gLbP  Rp @Cambria&L($`m1L( @%0(%= w1@%L( l w1`$7@Cambrip%8Dp1߬%jmn1%b2%ldv% % % % % %   TT_sg`A`A_LbP    TT_g`A`A_LbP    TT_g`A`A_LbP    TT_g`A`A_LbP    TT_g`A`A_LbP    TT_g`A`A_L6&bWMFC@@bP    TT_g`A`A_LbP    TT_g`A`A_LbP  % % ( 6b6b666a6a666`6`66  b.@"Arial------  2 9_b  ,b'@"Arial------  2 _b   2 tb  2 Mbpage n  2 kb1  2 rb  2 ubof   2 b1  2 b  ,b- @ !`]-'@"Arial------ .2 ]_bSelection Questionnaire        2 ]8b   @"Arial------  2 u_b   2 _bThis n  2 bquestionnaire     2 b  p2 Cbtells the Council about your firm or organisation and the kinds of                  b2 _:bbusiness that you would like an opportunity to tender for.              2 b   2 b    2 _b   2 _SbThe Council wishes in particular to create wider opportunities for small and micro                      2 _Rblocal enterprises and voluntary and community sector organizations to do business                      }2 _Lbwith it. The Council hopes that local firms and organizations will use this                   s2 _Ebquestionnaire to express their interest in participating in its work.                   2 'b  @"Arial------  2 _b  --- 42 _bYour objective in completin         2 bg this   2 J bquestionnaire     2 b  42 bis to demonstrate that you:       2 hb  @Symbol------------  2 '_b---  2 'fb --- 2 'wbare   J2 '*btechnically and professionally capable of             2 'bmeeting    2 'b  2 ' bthe Council   2 '@bs  2 'Lb  2 'Pbneedsn   2 '|b  ---  2 9_b---  2 9fb --- 2 9wbare   "2 9bable to commit      2 9bthe   2 9b  )2 9bstaff and resources      2 9bneeded  (2 9bto perform contract        2 9bbs successfully     2 9b   2 9b  ---  2 J_b---  2 Jfb --- 2 Jwbare   ,2 Jbsound financially, and      2 J+b  ---  2 \_b---  2 \fb --- +2 \wbhave in place the insd        b2 \:burance cover, policies, procedures and business practices                 /2 mwbrequired by the Council.       2 mb    2 ~_b   p2 _CbThe information you give will be used to help the Council decide whk                      2 8bich firms and      I2 _)borganizations are going to the next stage             2 ~b.  2 b   2 b  ---  2 _b  --- 2 _bTo   2 rb  L2 u+bminimise the amount of paperwork needed fro             G2 (bm you, the Council does not require you           ;2 _ bto provide supporting documents           2 Mb  2 Ub  X2 Y3bfor example, accounts, certificates, statements or            @ Arial-------- 2 _ bpolicies     2 b  2 b  "2 bwith this form.     --- 2  b --- b2 :bThe Council may, however, ask to see these documents at a            2 _ blater stageo   =2 !b, so it is advisable you make surr         O2 -be they can be made available on request. You               2 _Vbmay also be asked later to clarify your answers or provide more details about certain                     2 _bpoints.    2 b  ---  2 (_b  --- @2 8_#bThe information you supply in this           2 8Sbquestionnaire    C2 8%bwill be treated in confidence and in o            72 H_bcompliance with the Data Prott          b2 H1:bection Act 1998. Your information will not be shared with                 #2 Y_bany third party.      2 Yb  ---  2 k_b  --- m2 {_AbPlease answer every question, and pay attention to the Councils                2 {(bwording     2 {ab  2 {e babout the     22 _binformation to be supplied          2 b.  2 b    2 _b   q2 _DbAnswers to Sections A (Corporate Data) are for information only and                   2 A bwill not be     2 _Tbscored. Section B (Financial Data) will be scored on a Pass/Fail basis. Sections C                       k2 _@b(Technical Capability) and D (Business Approach) will be scored.                  2 %b    2 _b   2 _NbIf you believe that a question does not apply to you, please write N/A or Not                       #2 _bApplicable. If y    g2 =bou do not know the answer to a question, please explain why. e                   2 xb    2 _b   2 $_TbSome questions have word limits on responses, e.g. maximum 100 words. In drafting                       2 4_Xbyour response, focus initially on the essential points, then prune the text down to fit                       +2 E_bwithin the word limit        D2 E&bs. Using bullet points can save words.            2 Eb    2 V_b  @"Arial- - - - - -   2 g_b  @Cambria- - - - - -   2 _b     2 _b     2 _b     2 _b     2 _b     2 _b     2 _b     2 _b   "System- - bbaa``՜.+,0 hp|  #F  Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRTUVWXYZ_`cRoot Entry F?.bData =1TableGWordDocument 4`SummaryInformation(̽DocumentSummaryInformation8SMsoDataStore ..EX0PEI3JDPA==2 ..Item  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q