Young Lives Bradford Consortium

Application for Membership Form

Please type your responses and mark with an X in the appropriate boxes, e.g.

Yes / X
No

Where you are asked to make additional statements, please restrict your answers to a maximum of 250 words. Please complete all boxes, marking ‘n/a’ if not applicable.

Once complete, please e-mail the form to Dionne Norman at

Young Lives Bradford Consortium (YLBC) is a company limited by guarantee (registration no. xxxx)

Name of Organisation:
Registered Office Address:
Tel:
Fax:
Email:
Name of main contact person:
Address if different from above:
Date the organisation was started:

In completing the following questions please refer to the eligibility criteria section of the Membership Prospectus. Your responses will be treated in confidence. YLBC will ensure the safe and secure storage of all application documentation and the information you submit will be used solely for the purpose of assessing your application for consortium membership.

Part 1: Universal Criteria

All applicants are expected to complete this part of the application form.

Please answer all the questions as any omissions may delay the processing of your application.

SECTOR (NOT-FOR-PROFIT)[1]

Question 1:Does your organisation operate in the not-for-profit sector?

Yes
No

Question 2: What is the legal status of your organisation?

Please complete all that apply, including registration numbers

Legal Structure / Registration No.
Company limited by guarantee
Registered charity
Community Interest Company (limited by shares)*
Community Interest Company (limited by guarantee)
Other (please describe)

* Please note that CICs limited by shares are excluded from membership (see Membership Prospectus, p34).

PROVISION OF SERVICES TARGETED AT THOSE WHO ARE MOST IN NEED[2]

Question 3: Please use the space below to explain how you target those most in need and meet wider public benefit:

Question 4: Do you sign up to the consortium’s vision statement?

Yes
No

AREA OF OPERATION[3]

Question 5: Please use the space below to describe how you are a locally-rooted organisation in Bradford District:

COMMITMENT TO CONSORTIUM WORKING[4]

Question 6: Please use the space below to provide a brief statement in support of your commitment to working as part of the consortium, including explaining how you will contribute to the consortium’s values:

COMMITMENT TO SHARING EXPERTISE[5]

Question 7: Please use the space below to provide a brief statement of what sorts of expertise and skills you have that you would be prepared to share with fellow consortium members, along with an indication of how you might go about this:

Question 8: Would you like to be considered at this stage for full membership, as opposed to, associate membership of the consortium?

Yes
No

If you answered ‘yes’ to this question, you need to complete part 2 of the form.

If you answered ‘no’, i.e. you wish to apply for associate membership only at this stage, completion of part 2 is optional.

A key goal of xxx will be to support associates to make the transition to full membership status. If you answered ‘no’, please use the space below to summarise what support you feel you most need to be able to progress to full membership at some point in the future:

Please note that only organisations that are incorporated will be eligible for full membership. Unincorporated organisations will have the opportunity to become associate members and to convert to full members at some point in the future once they have become incorporated and met the full range of contract-readiness criteria.

Part 2: Contract-Readiness Criteria

Please complete this part of the application form if you wish to apply for full membership of the consortium. Please answer all the questions as any omissions may delay the processing of your application.

For those organisations that wish to apply for associate membership, this section is optional.

The following contract-readiness criteria are designed to mirror the criteria within typical Pre-Qualification Questionnaires (PQQ’s).

FINANCIAL HEALTH[6]

Please note that credit checks may be carried out and a poor credit rating may also exclude you from full membership.

Question 9: Who is the person with responsibility for your organisation’s financial matters and what is their role?

Name:
Role:

Question 10: What was your organisation’s overall financial position in the last three years?

Period / Turnover (£) / Expenditure (£) / Level of unrestricted reserves (£)
Year ended:
Year ended:
Year ended:

Question 11: Has your organisation met the terms of its banking facilities and loan agreements (if any) during the past year?

Yes
No

If “No” what were the reasons, and what has been done to put things right?

Question 12: Has your organisation met all its obligations to pay its creditors and staff during the past year?

Yes
No

If “No” please explain why not:

Question 13: What is the name and branch of your bankers (who could provide a reference)?

Name:
Branch address:
Telephone:

Question 14: Please attach the following with your application:

i)A copy of your most recent audited accounts (for the last three years if this applies)

Yes
No

ii)A statement of your turnover, profit & loss account and cash flow for the most recent year of trading

Yes
No

iii)If you are unable to provide i) and ii) above: a statement of your cash flow forecast for the current year and a bank letter outlining the current cash and credit position

Yes
No
n/a

iv)If you are a subsidiary of a group you must also provide the above i), ii) or iii) for the parent company

Yes
No
n/a

In cases where your organisation is a member of a group or ultimate holding company, would the holding company be prepared to guarantee your contract performance as its subsidiary?

Yes
No
n/a

Question 15: Is your organisation registered for VAT?

NB VAT registration is not a requirement of membership.

Yes
No

If yes, please provide your VAT registration number:

Question 16: Does your organisation have employer’s liability insurance?

Yes
No

If yes, please provide the following:

Name of insurer:
Policy number:
Level of cover (£):
Expiry date (NB the applicant organisation has a responsibility to keep all insurance cover up-to-date)

Question 17: Does your organisation have public liability insurance?

Yes
No

If yes, please provide the following:

Name of insurer:
Policy number:
Level of cover (£):
Expiry date:

Question 18: Does your organisation have professional indemnity insurance?

NB Professional indemnity insurance is not a requirement of full membership, but some contracts may require it.

Yes
No

If yes, please provide the following:

Name of insurer:
Policy number:
Level of cover (£):
Expiry date:

QUALITY SYSTEMS[7]

Question 19: Does your organisation possess an externally-validated quality mark?

NB It may be that your organisation doesn’t have such a quality mark in place at the moment, but is actively working towards achieving it.

Also, if you are part of a national organisation’s quality framework, and this involves some form of review/validation by the national body of the quality of your work, then this would satisfy this criterion.

Yes
No
Working Towards

If yes or working towards, which quality mark is it?

ISO 9001
Customer First
CHAS
PQASSO – externally accredited
MATRIX
Investors in People
Other (please specify)

If you are working towards, when do you expect to achieve the quality mark?

Question 20: Does your organisation have a structured approach to continuous improvement? For example, this could involve regularly reviewing and up-dating organisational policies and procedures, organising regular ‘away days’ for board and staff members etc.

Yes
No

If “Yes”, please give details:

SUITABLE ORGANISATIONAL POLICIES[8]

Health and Safety

Question 21: Does your organisation have a written health and safety at work policy?

Yes
No

If “No”, please explain why:

Question 22: Does your organisation have processes and procedures to ensure that health and safety is properly managed and compliant with relevant legislation?

Yes
No

If “No”, please explain why:

Equalities

Question 23: Does your organisation have a written equal opportunities policy?

Yes
No

If “No”, please explain why:

Question 24: Does your organisation have processes and procedures to ensure compliance with equalities legislation?

Yes
No

If “No”, please explain why:

Question 25: Do you have a safeguarding policy in place?

Yes
No

If ‘Yes’, what date was it last reviewed: ______

If “No”, please explain why:

Question 26: Does your organisation comply with the Disclosure and Barring Service (DBS) requirements?

Yes
No

If “No”, please explain why:

SUITABLE GOVERNANCE[9]

Question 27: Does your organisation’s governing document enable your organisation to:

  • Enter into contracts to fulfil your organisation’s primary purposes (objects)?

Yes
No
  • Work in partnership?

Yes
No

Question 28: If requested, would you be able to provide a signed and dated copy of your governing document (Memorandum and Articles of Association etc)?

Yes
No

TECHNICAL CAPACITY[10]

EXPERIENCE

Question 29: Please provide details of 2 contracts or large grant-funded projects (at least £20k in value) you have delivered over the past three years.

These may be used to obtain references. Where possible at least one should be from a Public Sector Organisation.

If you cannot provide details of 2 contracts that you have, please explain why:

i) Contract 1

Customer Organisation (name):
Customer contact (name):
Phone number:
E Mail address:
Contract award date:
Total length of time as a supplier to this customer:
Contract reference and brief description:
Contract Value:
Date contract was completed:
Explain how performance is monitored within the above contract:

How did your organisation improve outcomes for service users through this contract?

Please summarise any innovative solutions you brought to this contract?

ii) Contract 2

Customer Organisation (name):
Customer contact (name):
Phone number:
E Mail address:
Contract award date:
Total length of time as a supplier to this customer:
Contract reference and brief description:
Contract Value:
Date contract was completed:
Explain how performance is monitored within the above contract:

How did your organisation improve outcomes for service users through this contract?

Please summarise any innovative solutions you brought to this contract?

Question 30: Has your organisation had any contracts terminated for poor performance in the last 3 years?

Yes
No

If “Yes”, please give details of all occasions.

Question 31: Has your organisation not had a contract renewed for failure to perform to the terms of the contract, in the last 3 years?

Yes
No

If “Yes”, please give details of all occasions.

Question 32: Has your organisation been subject to an investigation by the Police or subject to a Coroner’s inquiry in the last 3 years?

Yes
No

If “Yes”, please give details of all occasions.

Question 33: Does your organisation possess each of the following ICT capabilities?

  • Reliable and continuous internet access

Yes
No
  • Holds its financial records on computer

Yes
No
  • Holds its performance management information on computer

Yes
No
  • An ICT Policy, which includes appropriate procedures for the safe and secure storage and usage of confidential and sensitive information, including data protection

Yes
No

Question 34: Do any of the following statements apply to your organisation, or to (any of) the director(s)/partners/proprietor(s)?

i) Is in a state of bankruptcy, insolvency, compulsory winding up, receivership, composition with creditors, or subject to relevant proceedings
Yes
No
ii) Has been convicted of a criminal offence related to business or professional conduct
Yes
No
iii) Has committed an act of grave misconduct in the course of business
Yes
No
iv) Has not fulfilled obligations related to payment of social security contributions
Yes
No
v) Has not fulfilled obligations related to payment of taxes
Yes
No
vi) Is guilty of serious misrepresentation in supplying information
Yes
No
vii) Is not in possession of relevant licences or membership of an appropriate organisation where required by law
Yes
No
If the answer to any of these is “Yes” please give brief details below, including what has been done to put things right.

DECLARATION

This declaration needs to be completed by all applicants. It must be submitted by two authorised people on behalf of the organisation, at least one of whom should be a member of the governing body (if it is not practical or feasible to get a member of the governing body to sign the declaration, e.g. because you are part of a national structure, another suitable individual with full delegated authority will be acceptable as a signatory).

We hereby apply to become a full/associate member of the Charity, a company limited by guarantee and agree to be bound by its memorandum and articles of association and any rules made under these. We confirm that our organisation:

  1. supports the Charity's aims and work and;
  2. has objects that are consistent with the Charity's

Should the Charity be wound up, we promise to pay the sum of up to £1 towards its debts, if asked to do so, and we understand that this liability will continue for one year after our organisation ceases to be a member of the Charity. We agree that the Charity may give out information about our organisation to other members.

We:

  1. Confirm that we are duly authorised to submit this declaration on behalf of the applicant organisation.
  2. Confirm that this application has been authorised by the management committee, other governing body or board.
  3. Confirm that we have read the YLBCMembership Prospectus and that we share the values of the consortium.
  4. Certify that the information given in this application is true and confirm that any enclosures are current, accurate and adopted or approved by our organisation.
  5. Understand that, if we make any seriously misleading statements (whether deliberate or accidental) at any stage during the application process, or if we knowingly withhold any information, this could make our application invalid.
  6. Understand that the Consortium Membership Panel may request additional information from us in support of our application.
  7. Understand that the decision of the Consortium Membership Panel is final.
  8. Understand that a copy of this form and any supporting papers, together with the written decision of the Membership Panel, will be retained on record by the Consortium.
  9. Agree, if this membership application is successful, to abide by the standing orders and rules of the Consortium.

Person One (Main Contact)
Name (please print)
Designation
Dated
Person Two
Name (please print)
Designation
Dated

YLBC Membership Form/viii/9 Dec 13Page 1

[1] See Membership Prospectus, p34.

[2]See Membership Prospectus, p35.

[3]See Membership Prospectus, p36.

[4]See Membership Prospectus, p36.

[5]See Membership Prospectus, p36.

[6]See Membership Prospectus, p37.

[7]See Membership Prospectus, p37.

[8]See Membership Prospectus, p37.

[9]See Membership Prospectus, p37.

[10]See Membership Prospectus, p38.