Standard Selection Questionnaire.docx

Standard Selection Questionnaire.docx

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StandardSelectionQuestionnaire

StandardSelectionQuestionnaire

PotentialSupplierInformationandExclusionGrounds:

Part1andPart2.

ThestandardSelectionQuestionnaireisaself-declaration,madebyyou（thepotentialsupplier）,thatyoudonotmeetanyofthegroundsforexclusion.Iftherearegroundsforexclusion,thereisanopportunitytoexplainthebackgroundandanymeasuresyouhavetakentorectifythesituation（wecallthisself-cleaning）.

AcompleteddeclarationofPart1andPart2providesaformalstatementthattheorganisationmakingthedeclarationhasnotbreachedanyoftheexclusionsgrounds.ConsequentlywerequirealltheorganisationsthatyouwillrelyontomeettheselectioncriteriatoprovideacompletedPart1andPart2.Forexamplethesecouldbeparentcompanies,affiliates,associates,oressentialsub-contractors,iftheyarereliedupontomeettheselectioncriteria.Thismeansthatwhereyouarejoininginagroupoforganisations,includingjointventuresandpartnerships,eachorganisationinthatgroupmustcompleteoneoftheseself-declarations.Sub-contractorsthatyourelyontomeettheselectioncriteriamustalsocompleteaself-declaration（althoughsub-contractorsthatarenotreliedupondonotneedtocompletetheself-declaration）.

Whencompleted,thisformistobesentbacktothecontactpointgivenintheprocurementdocumentsalongwiththeselectioninformationrequestedintheprocurementdocumentation.

NoteforContractingAuthorities:

Thefollowingparagraphisoptionalforinclusion,authoritiescandeleteitiftheyprefertoreceiveonlyWord/PDFversionsofthestandardSelectionQuestionnaire.[AlternativelyyoucansubmitthecompletedExclusionGroundsoftheEUESPD（PartIII）asadownloadedXMLfiletothebuyercontactpointalongwiththeselectioninformationrequestedintheprocurementdocumentation.]

SupplierSelectionQuestions:

Part3

Theprocurementdocumentwillprovideinstructionsontheselectionquestionsyouneedtorespondtoandhowtosubmitthoseresponses.Ifyouarebiddingonbehalfofagroup（consortium）oryouintendtousesub-contractors,youshouldcompletealloftheselectionquestionsonbehalfoftheconsortiumand/oranysub-contractors.

IftherelevantdocumentaryevidencereferredtointheSelectionQuestionnaireisnotprovideduponrequestandwithoutdelaywereservetherighttoamendthecontractawarddecisionandawardtothenextcompliantbidder.

Consequencesofmisrepresentation

IfyouseriouslymisrepresentanyfactualinformationinfillingintheSelectionQuestionnaire,andsoinduceanauthoritytoenterintoacontract,theremaybesignificantconsequences.Youmaybeexcludedfromtheprocurementprocedure,andfrombiddingforothercontractsforthreeyears.Ifacontracthasbeenenteredintoyoumaybesuedfordamagesandthecontractmayberescinded.Iffraud,orfraudulentintent,canbeproved,youoryourresponsibleofficersmaybeprosecutedandconvictedoftheoffenceoffraudbyfalserepresentation,andyoumustbeexcludedfromfurtherprocurementsforfiveyears.

[INSERTPROCUREMENTNAME]

[INSERTREFERENCENUMBER]

[INSERTPROCUREMENTPROCEDUREe.g.OPEN,RESTRICTED]

Notesforcompletion

1.The“authority”meansthecontractingauthority,oranyoneactingonbehalfofthecontractingauthority,thatisseekingtoinvitesuitablecandidatestoparticipateinthisprocurementprocess.

2.“You”/“Your”referstothepotentialsuppliercompletingthisstandardSelectionQuestionnairei.e.thelegalentityresponsiblefortheinformationprovided.Theterm“potentialsupplier”isintendedtocoveranyeconomicoperatorasdefinedbythePublicContractsRegulations2015（referredtoasthe“regulations”）andcouldbearegisteredcompany;theleadcontactforagroupofeconomicoperators;charitableorganisation;VoluntaryCommunityandSocialEnterprise（VCSE）;SpecialPurposeVehicle;orotherformofentity.

3.Pleaseensurethatallquestionsarecompletedinfull,andintheformatrequested.Ifthequestiondoesnotapplytoyou,pleasestate‘N/A’.Shouldyouneedtoprovideadditionalinformationinresponsetothequestions,pleasesubmitaclearlyidentifiedannex.

4.Theauthorityrecognisesthatarrangementssetoutinsection1.2ofthestandardSelectionQuestionnaire,inrelationtoagroupofeconomicoperators（forexample,aconsortium）and/oruseofsub-contractors,maybesubjecttochangeandwill,therefore,notbefinaliseduntilalaterdate.TheleadcontactshouldnotifytheauthorityimmediatelyofanychangeintheproposedarrangementsandensureacompletedPart1andPart2issubmittedforanyneworganisationreliedontomeettheselectioncriteria.Theauthoritywillmakearevisedassessmentofthesubmissionbasedontheupdatedinformation.

5.ForPart1andPart2everyorganisationthatisbeingreliedontomeettheselectionmustcompleteandsubmittheself-declaration.

6.NoteforContractingAuthorities:

Thefollowingparagraphisoptionalforinclusionifadecisionhasbeenmadetorequestaself-declarationoftheexclusiongroundsfromsub-contractors.Allsub-contractorsarerequiredtocompletePart1andPart2.

7.ForanswerstoPart3-Ifyouarebiddingonbehalfofagroup,forexample,aconsortium,oryouintendtousesub-contractors,youshouldcompleteallofthequestionsonbehalfoftheconsortiumand/oranysub-contractors,providingonecompositeresponseanddeclaration.

Theauthorityconfirmsthatitwillkeepconfidentialandwillnotdisclosetoanythirdpartiesanyinformationobtainedfromanamedcustomercontact,otherthantotheCabinetOfficeand/orcontractingauthoritiesdefinedbytheregulations,orpursuanttoanorderofthecourtordemandmadebyanycompetentauthorityorbodywheretheauthorityisunderalegalorregulatoryobligationtomakesuchadisclosure.

Part1:

PotentialsupplierInformation

Pleaseanswerthefollowingquestionsinfull.NotethateveryorganisationthatisbeingreliedontomeettheselectionmustcompleteandsubmitthePart1andPart2self-declaration.

Section1

Potentialsupplierinformation

Questionnumber

Question

Response

1.1（a）

Fullnameofthepotentialsuppliersubmittingtheinformation

1.1（b）–（i）

Registeredofficeaddress（ifapplicable）

1.1（b）–（ii）

Registeredwebsiteaddress（ifapplicable）

1.1（c）

Tradingstatus

a）publiclimitedcompany

b）limitedcompany

c）limitedliabilitypartnership

d）otherpartnership

e）soletrader

f）thirdsector

g）other（pleasespecifyyourtradingstatus）

1.1（d）

Dateofregistrationincountryoforigin

1.1（e）

Companyregistrationnumber（ifapplicable）

1.1（f）

Charityregistrationnumber（ifapplicable）

1.1（g）

HeadofficeDUNSnumber（ifapplicable）

1.1（h）

RegisteredVATnumber

1.1（i）-（i）

Ifapplicable,isyourorganisationregisteredwiththeappropriateprofessionalortraderegister（s）inthememberstatewhereitisestablished?

Yes

No

1.1（i）-（ii）

Ifyourespondedyesto1.1（i）-（i）,pleaseprovidetherelevantdetails,includingtheregistrationnumber（s）.

1.1（j）-（i）

Isitalegalrequirementinthestatewhereyouareestablishedforyoutopossessaparticularauthorisation,orbeamemberofaparticularorganisationinordertoprovidetheservicesspecifiedinthisprocurement?

Yes

No

1.1（j）-（ii）

Ifyourespondedyesto1.1（j）-（i）,pleaseprovideadditionaldetailsofwhatisrequiredandconfirmationthatyouhavecompliedwiththis.

1.1（k）

Tradingname（s）thatwillbeusedifsuccessfulinthisprocurement

1.1（l）

Relevantclassifications（statewhetheryoufallwithinoneofthese,andifsowhichone）

a）VoluntaryCommunitySocialEnterprise（VCSE）

b）ShelteredWorkshop

c）Publicservicemutual

1.1（m）

AreyouaSmall,MediumorMicroEnterprise（SME）?

Yes

No

1.1（n）

DetailsofPersonsofSignificantControl（PSC）,whereappropriate:

-Name;

-Dateofbirth;

-Nationality;

-Country,stateorpartoftheUKwherethePSCusuallylives;

-Serviceaddress;

-ThedateheorshebecameaPSCinrelationtothecompany（forexistingcompaniesthe6April2016shouldbeused）;

-WhichconditionsforbeingaPSCaremet;

-Over25%upto（andincluding）50%,

-Morethan50%andlessthan75%,

-75%ormore.

（PleaseenterN/Aifnotapplicable）

1.1（o）

Detailsofimmediateparentcompany:

-Fullnameoftheimmediateparentcompany

-Registeredofficeaddress（ifapplicable）

-Registrationnumber（ifapplicable）

-HeadofficeDUNSnumber（ifapplicable）

-HeadofficeVATnumber（ifapplicable）

（PleaseenterN/Aifnotapplicable）

1.1（p）

Detailsofultimateparentcompany:

-Fullnameoftheultimateparentcompany

-Registeredofficeaddress（ifapplicable）

-Registrationnumber（ifapplicable）

-HeadofficeDUNSnumber（ifapplicable）

-HeadofficeVATnumber（ifapplicable）

（PleaseenterN/Aifnotapplicable）

Pleasenote:

Acriminalrecordcheckforrelevantconvictionsmaybeundertakenforthepreferredsuppliersandthepersonsofsignificantincontrolofthem.

Pleaseprovidethefollowinginformationaboutyourapproachtothisprocurement:

Section1

Biddingmodel

Questionnumber

Question

Response

1.2（a）-（i）

Areyoubiddingastheleadcontactforagroupofeconomicoperators?

Yes

No

Ifyes,pleaseprovidedetailslistedinquestions1.2（a）（ii）,（a）（iii）andto1.2（b）（i）,（b）（ii）,1.3,Section2and3.

Ifno,andyouareasupportingbidderpleaseprovidethenameofyourgroupat1.2（a）（ii）forreferencepurposes,andcomplete1.3,Section2and3.

1.2（a）-（ii）

Nameofgroupofeconomicoperators（ifapplicable）

1.2（a）-（iii）

Proposedlegalstructureifthe