ࡱ> { bjbjzz 4T||8"Lnd8( L ()7+7+7+7+7+7+7$:=^O7!!!O77"""!^)7"!)7""4S67u!577085>'"|>(S6S6&>y6"!!!O7O7"!!!8!!!!>!!!!!!!!!| : 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 meet the minimum requirements for the council to evaluate your Method Statement. 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. You will not pre-qualify unless you comply fully and exactly. 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 and the minimum score acceptable in this section is 20 anything less than that will be a fail. 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. If you have any questions about completing this form please contact: Melody Mapfumo on 01162527118 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?  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 10 million for Public Liability, 5 million for Employers Liability and 2 million 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 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. 10DATA PROTECTION 10.1Does your organisation apply procedures for the protection of personal information about individuals in conformity with the Data Protection Act 1998? 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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. 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 7. Experience and reference contracts 7.1-7.8 overall 5 full and detailed information 3 useful information but some details missing 0 no detailed information given will be a Fail 10. 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