Request for Proposalfor:

IT Infrastructure Managed Services

Respondent’s Information
Name of Organisation:
Address of registered office:
Place of registration:
Australian Company Number:
Australian Business Number:
Principal office (if different to the above):
Telephone:
Email:
Name and title of Respondent’s authorised agent:

I accept the provisions contained in the Conditions of this Expression of Interest.

Signature Respondent’s authorised agent PRINT NAME and DATE
1.Relevant Experience and Capability
1.1 Outline the nature and extent of previous and current experience in delivering similar services particularly in relation to provision of services forIT Infrastructure Managed Services
(Weighting 25%)
1.2 Outline in anattached document, willingness, capability and proposed strategies to deliver the goods and services as detailed in Appendices A and Boutline the scope, specifications and Statement of Work required, including an approximate project timeline (where applicable).
(Weighting 60%)
2.Pricing
2.1 Please complete the following table outlining your organisation’s proposed pricing for service delivery.
(Weighting 15%)
As part of your RFP Response, potential applicants must to use the tables below to insert details of all relevant charges, costs or fees for the performance of the products and/or services.
Monthly Endpoint Rates
Charges (GST exclusive) / GST Component / Total (inclusive of GST)
Monthly Service Charges – per Qualifying Endpoint supported

Hourly Rates

Hourly Rate (exclusive of GST) / GST Component / Total (inclusive of GST)
In scope Managed Services Personnel
Out of Scope Hourly Rates
Hourly Rate (exclusive of GST) / GST Component / Total (inclusive of GST)
Managed Services Personnel

Hourly Rates Out of Scope; Out of Hours

Hourly Rate (exclusive of GST) / GST Component / Total (inclusive of GST)
Managed Services Personnel
Any Other Charges (supply details)
Hourly Rate (exclusive of GST) / GST Component / Total (inclusive of GST)
3.Compliance
3.1 Financial stability/sustainability screening:
YES / NO
Are there any significant events, matters or circumstances which have arisen since the end of the last financial year which may significantly affect the operations of the Applicant?
If yes – comment here:
Are there any proceedings, whether actual or threatened, against the Applicant, its parent or associated entities or have there been any such proceedings within the past 5 years? If so, what (if any) remedial action has been taken in respect of such proceedings?
If yes – comment here:
Are there any bankruptcy actions against a director of the Applicant, its parent or associated entities, or have there been any within the past 5 years?
If yes – comment here:
Are there any deregistration actions against the Applicant, its parent or associated entities on foot, or has there been any within the past five years?
If yes – comment here:
Are there any insolvency proceedings, actual or threatened (including voluntary administration, application to wind up, or other like action) against the Applicant, its parent or associated entities on foot, or have there been any within the past five years?
If yes – comment here:
Is the Applicant, its parent or associated entities currently in default of any agreement, contract, order or award that would or would be likely to adversely affect the financial capacity of the Applicant to provide the Services contemplated by this Invitation?
If yes – comment here:
Are there any other factors which could adversely impact on the financial ability of the Applicant to successfully perform the obligations contemplated by this Invitation?
If yes – comment here:
Is the Applicant solvent and able to meet its debts as and when they fall due in the normal course of business?
3.2 Conflict of Interest
Provide details of any interests, relationships or clients which may or do give rise to a conflict of interest and the area of expertise in which that conflict or potential conflict does or may arise, and details of any strategy for preventing conflicts of interest.
3.3 Please provide the names and contact details of two referees who are familiar with your recent work.
In providing these details the applicant confirms that prior consent to the disclosure of such information and the provision of a reference to CHN has been secured and that CHN may contact either or each of the named contacts for further information.
Name:
Company name:
Position in company:
Email:
Phone:
Name:
Company name:
Position in company:
Email:
Phone:
3.4 Insurances
Provide details of all relevant insurances maintained by the Applicant. (Note: ACT PHN may seek confirmation of such Insurances through the provision of certificates of currency). (Add additional rows as necessary).
Name of insurance company:
Policy type (e.g. public liability, professional indemnity, etc.):
Policy number(s):
Expiry dates:
Limit of liability:
Relevant exclusions:
Name of insurance company:
Policy type (e.g. public liability, professional indemnity, etc.):
Policy number(s):
Expiry dates:
Limit of liability:
Relevant exclusions:
Please add additional rows as necessary

Please remember to complete this documentation, attach your response to the Statement of requirements and pdf and email to

Page 1 of 6