Request for Quote: Supplier Response Page 2 of 4

Request for Quote (RFQ):

Supplier Response

Department of Communities, Child Safety and Disability Services

RFQ Title: Youth Support Services in North Queensland Region – Burdekin/Ayr

Reference No: COM-0170a

Date of Issue: Monday, 8 February 2016

Request for Clarification Cut Off: Monday, 22 February 2016

Closing Date: Monday, 29 February 2016

Contact Officer: Senior Procurement Officer

Contact Phone Number: 07 3008 5128

Email:

Section 3 – Supplier Response

(Supplier to complete and sign Section 3 and return all sections)

Supplier response to Request for Quote
Supplier name / <insert>
ACN/ABN / <insert>
Address / <insert>
Postal Address
(if different from above) / <insert>
Contact Person
Name:
Position:
Phone number:
Email: / <insert>
<insert>
<insert>
<insert>
Service Name / Provide the service outlet name that this service will operate under: <insert>
Quote details and specifications / Provide your response to evaluation criteria limited to eight (8) pages, plus the Pricing Schedule. Your response may be inserted here or a stand-alone response to the relevant criteria will also be accepted.
If your response is provided as an attachment rather than within this template, state the attachment number here and clearly number pages in your response.
Additional attachments may be provided, however, if the information is critical to the response to the criteria, it should be provided within the page limit.
Please Note: Letters of support and financial statements are not required.
Your response should address the following criteria (full descriptions can be found on the accompaning Request for Quote:
1: Service Delivery Model
2: Capacity, including cultural capability and collaboration.
3: Value for money and Pricing Schedule
Note: Requirement to complete Attachment D –Pricing Schedule
Limited Establishment costs may be available upon request. Provide a detailed rationale in your response and cost breakdown that might include purchase of assets, set-up and other costs associated with establishing the service within the Pricing Schedule at Attachment D
Deviation from the Specifications
(if applicable) / <insert>
Additional information / Not applicable.
Warranty details
(if applicable) / Not applicable.
Departures from the Contract / Not applicable.
Pricing information
Price / Supplier is required to submit pricing information as outlined in Attachment D – Pricing Schedule.
Schedule of rates
(if applicable) / Not applicable.
Payment milestones
(if applicable) / Payment milestones will be payable in accordance with the Service Agreement – Standard Terms Version 1.1 – dated 17 February 2015.
Insurance Details
/ For any insurance policies specified in Section 1 (other than Workers’ Compensation insurance), provide the following details:
Policy no.:
Insurance provider:
Named insured:
Expiry date of policy: / Workers compensation as required by law:
<insert>
<insert>
<insert>
<insert>
Sum insured:
Policy no.:
Insurance provider:
Named insured:
Expiry date of policy: / Public liability minimum amount of $10 million per claim:
<insert>
<insert>
<insert>
<insert>
<insert>
Declarations
Conflict of Interest / Suppliers must give details of any possible Conflict of Interest that exists or may arise in relation to the making and/or acceptance of their quote. If there is nothing to declare, please insert “None”.
<insert>
Authorisation and execution by Supplier / As the authorised officer named below, I certify that:
(a)  I am authorised to submit the Supplier’s response as the Supplier’s representative.
(b)  The Supplier understands and has complied with the Requirements of the Request for Quote.
(c)  The Supplier’s response is complete, accurate and not misleading in any way.
Name: / <insert>
Position: / <insert>
Signature: / <insert>
Date: / <insert>

Youth Support Services in North Queensland Region – Burdekin/Ayr February 2016


Request for Quote: Supplier Response Page 2 of 4

Youth Support Services in North Queensland Region – Burdekin/Ayr February 2016