Annexure – A:

Participants Questionnaire: Stakeholder Consultation Workshop for Outsourcing of Laboratory Services Scheduled on 20th February, 2015

1.  / Name of the Service Provider
2.  / Name of Contact person
3.  / Contact Details / Address:
Contact No.:
Tel:
Mob:
Fax:
E-mail:
4.  / Expected participation as Sole Bidder/ Prime Respondent / Consortium Partner
5.  / Experience (In years) of operating Laboratory / Pathology Centres in India / a.  More than 1 Year
b.  More than 3 Year
c.  More than 5 Year
d.  More than 10 Year
e.  More than 15 Year
6.  / Total Nos of Operational Laboratory / Pathology Centres in India / a.  More than 5 Labs
b.  More than 10 Labs
c.  More than 15 Labs
d.  More than 20 Labs
e.  More than 25 Labs
7.  / Total Nos of NABL accredited Laboratory / Pathology Centres in India / a.  More than 1
b.  More than 3
c.  More than 5
d.  More than 8
e.  More than 10
8.  / Total Nos of NABL accredited Laboratory / Pathology Centres in Uttar Pradesh / a.  More than 1
b.  More than 3
c.  More than 5
d.  More than 8
e.  More than 10
9.  / Total Nos of Collection Centres in India / a.  More than 10
b.  More than 50
c.  More than 100
d.  More than 200
e.  More than 500
10.  / Total Nos of Collection Centres in Uttar Pradesh / a.  More than 10
b.  More than 30
c.  More than 50
d.  More than 75
e.  More than 100
11.  / Work experience in Public Private Partnership for outsourcing Laboratory Services / If yes, please mention below no of years:
a.  More than 1 Year
b.  More than 3 Year
c.  More than 5 Year
Please mention below total no of projects under PPP:
a.  1
b.  More than 1
c.  More than 3
d.  More than 5
12.  / Total turnover of last five financial years / a.  2009-2010 –
b.  2010-2011 –
c.  2011-2012 –
d.  2012-2013 –
e.  2013-2014 –

Note: Kindly fill and attach this annexure with complete details along with your confirmation for participation in the Workshop through e-mail on or