New Forest District Council - in CONFIDENCE

New Forest District Council - IN CONFIDENCE

Form 2. PRE-QUALIFICATION QUESTIONNAIRE (Contract for the Provision and Support of Desktop PC and Server Hardware, Software, Peripherals and Network Infrastructure)

Please complete in BLOCK LETTERS or typescript. Tick boxes where applicable. If you need more space for any of your answers, please continue on a separate sheet of paper and attach it to this form

N.B. Tender Documents will not be sent out until this form has been completed in full and returned to New Forest District Council

PART A – Company Information
1. Name of Company:
1a. Are you aware of any intention to change your company name? / Yes [ ] No [ ]
2. Head Office Address
Telephone:
Fax:
E-mail:
Web Address:
3. Branch Office Addresses / Please list address for correspondence and state registered office, (if different from Head Office), and all branch office details
Telephone:
Fax:
E-mail:
Web Address:
Telephone:
Fax:
E-mail:
Web Address:
4. Date your Company was formed: / 5. If a Limited Company, date it was incorporated:
6. Company Registration No: / 7. V.A.T. No
8. Associated Companies / If the company is a member of a group of companies, give the names and addresses of the ultimate holding company and associated companies. State relationship clearly (e.g. parent or holding company, subsidiary, wholly or partly under common control)
9. Number of Employees: /
10. Other relevant Company information
11. Contact Information / Please give details of the person who should be contacted in all matters relating to this application.
Full name:
Job Title:
Address (including postcode):
Telephone and fax numbers:
Mobile Phone:
E-mail:
12. Directors, Partners, etc / Please give details of:
- every Director, Partner and Secretary including any name changes in the preceding 5 years.
- anyone holding more than 20% of the paid-up share or loan capital
Sole Traders and Partnerships - please include
- all persons with a financial interest in the company.
Full names:
Postcode of private address:
Position in Company:
Date of Birth:
Nationality:
If a Director or major shareholder of any other companies list them here:
Is this person employed by the Government? / Yes [ ] No [ ] / Yes [ ] No [ ] / Yes [ ] No [ ]
Full names:
Postcode of private address:
Position in Company:
Date of Birth:
Nationality:
If a Director or major shareholder of any other companies list them here:
Does the Government employ this person ? / Yes [ ] No [ ] / Yes [ ] No [ ] / Yes [ ] No [ ]
13. If any of the persons named in Section 10 within the last 5 years been Directors of or shareholders in any other company engaged in similar types of work please give details:
PART B - Your Finances
14. What is the name of the person in the company responsible for financial matters; what position does he/she hold?
15. Parent company company guarantee
If the firm is a wholly owned subsidiary of a group or parent company which will be guaranteeing it’s contract performance, please also forward their accounts as 16.
16. Finance Documents
Please enclose with this form one copy of:
- The last 3 years of your Company’s full audited accounts (as prepared for its shareholders) and
the full audited accounts of any Ultimate Holding Company these must be consolidated
These audited accounts should be the latest available in line with Companies House Requirements
i.e. 6 months from the end of the period to which they relate for Plc companies and 10 months for Ltd companies
and these accounts must include:
- the balance sheet (signed and dated)
- the profit and loss account
- the trading account (if applicable)
DRAFT ACCOUNTS ARE NOT ACCEPTABLE / - the Directors Report
- the Auditors Report (signed and dated) *
- any notes to the accounts
Sole Traders and Partnerships - please provide:
- a detailed profit and loss account and balance sheet. These should be signed by the Sole Trader/Partner and by the Accountant (where applicable) as a true representation of their business affairs.
These documents will be returned if requested.
* Companies need not supply an Auditor’s report if they are exempted under the Companies Act 1985 (Audit Exemption) Regulations 1994.

ENCLOSED Yes [ ] No [ ]

PART C – References for Completed Contracts
17. Are you on any other Public Sector Approved Lists?
If Yes, please specify:
Name of list
Managing body
Address
(inc. postcode)
18. What relevant contracts have you recently completed?
Your examples should include the 2 highest value contracts completed within the last 4/5 years.
If appropriate, include work for Government Departments/local authorities or other public bodies.
Category of work:
Reference 1 / Reference 2
Client contact name
Full address
Post Code
Telephone
Project Consultant
(or other contact)
Full address
Post Code
Value
Location
Description of work
Contract/ref number
Dates (approx)
19. Insurance Details
Please give details of insurance as indicated below, supplying in each case a copy of the policy held by you in relation to that insurance.
Insurance / Expiry Date / Value (£) / Insurer Policy No
Professional Indemnity (minimum{insert figure})
Employer’s Liability
(minimum £10m)
Public Liability (Third Party)
(minimum £10m)
PART D - General
20. Quality Assurance
Do you hold certification for any Quality Management Systems? Yes [ ] No [ ] In Preparation [ ]
If so please give details below:
PART E - Equal Opportunities
21. Do you undertake to comply with: -
UK Equal Opportunities Legislation
and Equalities Standard Yes [ ] No [ ]
Minimum Wage Legislation Yes [ ] No [ ]
The Race Relations Act and Codes of Practice Yes [ ] No [ ]
Disability Employment and Discrimination Yes [ ] No [ ]
22. Racial Equality
(I) / Is it your policy as an employer to comply with your statutory obligations under the Race Relations Act and, accordingly, your practice not to treat one group of people less favourably than others because of their colour, race, nationality or ethnic origin in relation to decisions to recruit, train or promote employees
Yes [ ] No [ ]
(ii) / In the last three years has any finding of unlawful racial discrimination been made against your organisation by any court or industrial tribunal ?
Yes [ ] No [ ]
(iii) / In the last three years has your organisation been the subject of a formal investigation by the Commission for Racial Equality on grounds of alleged unlawful discrimination ?
Yes [ ] No [ ]
(iv) / If the answer to (iii) is yes, what steps did you take in consequence of that finding?
(v) / Is your policy on race relations set out;
(a) / in documents available to employees, recognised trade unions or other recognised groups of employees ?
Yes [ ] No [ ]
(b) / In recruitment advertisements or other literature ? Yes [ ] No [ ]
(vi) / Do you observe as far as possible the Commission for Racial Equality’s Code of Practice for Employment, as approved by Parliament in 1983, which gives practical guidance to employers and others on the elimination of racial discrimination and the promotion of equality of opportunity in employment, including the steps that can be taken to encourage members of ethnic minorities to apply for jobs or take up training opportunities ?
Yes [ ] No [ ]
PLEASE SUPPLY RELEVANT EXAMPLES OF THE INSTRUCTIONS, DOCUMENTS, RECRUITMENT ADVERTISEMENTS OR OTHER LITERATURE.
ENCLOSED Yes [ ] No [ ]
PART F - Health and Safety
You are advised to have this section completed by your Health & Safety Officer. When completing the questions please ensure that where reference is made to supporting documents that you detail exactly where the documentation can be found. (e.g. Health & Safety Policy Section 3 Page 12)
Please enclose a copy of your Health & Safety Policy, this should contain the following: -
a)General Health & Safety Policy Statement signed and dated.
b)Responsibilities (who in the company is responsible for implementing the policy) and a company Health & Safety organisation chart.
c)The arrangements for carrying out the policy.
ENCLOSED Yes [ ] No [ ]
NB: Where the arrangements are contained within large manuals or on a CD you are required to provide the index for the manual and appropriate examples to show how you address the health & safety risks arising from your work activities.
You should provide the following general procedures: Training; Accident and Incident Reporting; Procedures for undertaking General Risk Assessments and COSHH Assessments; Emergency Arrangements; First Aid; PPE, Health Surveillance and arrangements for assessing Health and Safety competence of sub-contractors.
23. Give the name and position of the person responsible for the implementation of your company’s Health and Safety Policy.
24. Does your company operate Health & Safety procedures as required under current legislation? (see for more information)
Yes [ ] No [ ]
25. Has your company, during the last five years been investigated or prosecuted under Health & Safety legislation? (including all trading names for which your company is responsible)
Yes [ ] No [ ]
(If the answer is Yes to the above question, please give full details)
PART G - Professional Conduct
26. Have any of the officers been bankrupt or involved in any company, which has been liquidated or gone into receivership?
Yes [ ] No [ ]
If Yes, please give details
27. In the last five years have any adverse complaints been upheld against your company to anyTrade Association/Federation or Professional body in respect of any work of the company?
Yes [ ] No [ ]
28. Has the company or any staff within the company been convicted of a criminal offence relating to the conduct of the business or profession?
Yes [ ] No [ ]
29. Has your company ever had a Public Sector contract terminated or had your employment determined under the terms of a contract within the Public Sector?
Yes [ ] No [ ]
IF THE ANSWER TO QUESTIONS 27, 28 or 29 IS YES, PLEASE ENCLOSE FULL DETAILS
ENCLOSED Yes [ ] No [ ]

PART H – Environmental Practices

30. Have you a Director with responsibility for Environmental Matters? Yes [ ] No [ ]

Please give details

31. Have you got an Environmental Policy? Yes [ ] No [ ]

Please attach your Environmental Policy Statement. ENCLOSED [ ]

32. Are you working to an Environmental Strategy or are you accredited to ISO 14001

Yes [ ] No [ ]

If yes please attach a copy of the Environmental Strategy or certificate of accreditation to ISO140001

ENCLOSED [ ]

33. Please list any current permits, licences, authorizations, certifications and memberships of professional associations appropriate to your business and provide documentary evidence.

34. Have you an EMAS / Sustainability Policy Yes [ ] No [ ]

If yes please attach a copy of the policy

WHEN YOU HAVE COMPLETED THE APPLICATION FORM, PLEASE READ AND SIGN THE SECTION ON THE NEXT PAGE
Payment of Sub-contractors and Suppliers
In signing this form you are confirming that should you be awarded a contract you will comply with Government policy relating to the prompt payment of sub-contractors.
PART J - Signatures
This declaration must be signed by the person who filled in the application form and by the Managing Director, Senior Partner or Sole Trader.
I/We certify that the information supplied is accurate to the best of my/our knowledge and that I/we accept the conditions and undertakings requested in the application form. I/We understand that false information could result in my/our exclusion from this Approved/Select List(s) and could result in my/our exclusion from existing Select Lists and future Approved/Select List(s).
Signature
Name
Date
Position in Company
Telephone
Fax
E-mail
Please return this form to:
(insert details)
Telephone (insert details)

Pre-qualification questionnaire