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					                    PRE-QUALIFICATION QUESTIONNAIRE
                          Health Partnership Scheme

                                                29 November 2010




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HEALTH PARTNERSHIP SCHEME PRE-QUALIFICATION QUESTIONNAIRE



CONTENTS

PART A GENERAL 3
1.     Introduction and Background 3
2.     The
Requirement…..……………………………………………………………………..…………6
3.     Procurement Process 3
4.     Conflicts of Interest 3
5.     Timetable       3
6.     Instructions for Completion 3
7.     Consortium and sub-contracting        3
8.     Queries about the procurement         3
9.     Supplier contact point 3
10.    Evaluation Approach 3
11     Confidentiality and Publication of Information    3
12     Freedom of Information and Environmental Information Regulations 3
13     Publicity       3
14     Reliance on Information       3
15     Costs of the Procurement      3
16     Collusion and Canvassing      3
17     Change of Control or Information Provided in the PQQ   3
18.    Pre-Qualification Questionnaire       3
PART B-ENCLOSURES             3




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PART A GENERAL

1.    Introduction and Background

1.1 Definitions and abbreviations
The following is a list of the key definitions and abbreviations used throughout this document.


Term                                               Definition
Authority                                          This refers to the contracting body, the
                                                   Department for International Development
EU Restricted Procedure                            A two-stage process allowing a short-list of
                                                   interested parties to be established during a
                                                   pre-qualification stage, prior to the issue of ITT
                                                   documents.

1.2 Purpose of this document
The purpose of this document is for DFID to seek Responses from Respondents wishing to be
selected to tender for the Contract.

It is envisaged that between three and five successful Respondents will be invited to participate
further in the procurement process and will be invited to tender for provision of the Services. The
Contract duration will be four years.

This is a competitive procurement conducted in accordance with the Restricted Procedure, under
the UK Public Contracts Regulations 2006.

1.3   Background Information

Department for International Development Structure
The UK government believes it is in all our interests to help poor people build a better life for
themselves. So in 1997 it created a separate government department - the Department for
International Development (DFID) - to meet the many challenges of tackling world poverty. It is
DFID’s job to make sure every pound of British aid works its hardest to help the world’s poor.
Our structure and staff
DFID is the part of the UK government that manages Britain's aid to poor countries and works to
get rid of extreme poverty. We are led by a cabinet minister, one of the senior ministers in the
government. This in itself is a sign of how determined is the UK government to tackle poverty
around the world.
We work in 150 countries and have 2,600 staff, half of whom work abroad. We have
headquarters in London and East Kilbride, near Glasgow, and 64 offices overseas.
Our work is guided by two sets of targets. First, we are working to reach the Millennium
Development Goals (MDGs), international targets agreed by the United Nations (UN) to halve
world poverty by 2015. Second, the government’s Public Service Agreement (PSA) sets
objectives and targets by which we measure our progress towards this aim.
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We work with governments of developing countries, charities, businesses and international
bodies, including the World Bank, UN agencies and the European Commission. All our partners
share our ambition to achieve the Millennium Development Goals.
In 2008/09 we spent £5.5 billion on aid to poorer countries and our budget will increase to £7.8
billion by 2010/11. By 2013, the equivalent of 0.7% of the UK’s gross national income will be
dedicated to development assistance, from 0.36% in 2007/08.
What is the legal basis for our work?
The legal basis for our work is the International Development Act 2002. The act allows the
secretary of state for international development (the cabinet minister who heads this department)
to provide aid for sustainable development and welfare. But the secretary of state must make
sure that the aid is likely to contribute to reducing poverty. Under the act, British aid cannot be
tied to British goods and services. (Since 1997, governments receiving UK aid have been free to
use suppliers who compete on price, quality and service alone.)
We also work within the International Development Act (Reporting and Transparency) 2006.
This act requires the secretary of state to report every year on how much we spent on aid, how
effective it was in reducing poverty and how much we gave to poor countries.
The National Audit Office (NAO) keeps a watch on public spending for parliament. It audits the
accounts of all government departments and agencies, including DFID.
The NAO reports to the Parliament and the Public Accounts Committee, which analyses the
value for money of DFID’s work. In parliament the International Development Committee (IDC)
scrutinises our annual report and also holds inquiries into particular areas of our work.

Our values
Our values set out how we mean to live up to our strategic aim of halving world poverty by
2015. Over the next three years, we expect to have a more flexible and influential workforce in a
more challenging yet supportive sphere of work.
Our values include:
   ● ambition and determination to eliminate poverty
   ● diversity and the need to balance work and private life
   ● ability to work effectively with others
   ● desire to listen, learn and be creative
   ● professionalism and knowledge.



2.1    Overview of Requirement
The Health Partnership Scheme is a UK Government-funded initiative designed to facilitate the
sharing of experience and equipment between UK-based health professionals and organisations,
and health systems in low-income countries. A service provider is being sought to be
responsible for establishing a framework for the assessment of funding applications, the
awarding and fiduciary management of funds to successful projects, the monitoring and
evaluation of projects, and reporting results back to the UK Government. The Health
Partnership Scheme will have four strands of activity: large-scale, multi-country projects focused
on UK Government designated priority countries and health needs; smaller, paired institutional
partnerships linked to any low-income country and health related theme; long-term volunteering
placements for UK health workers overseas; and the establishment and operation of a
‘Healthbay’ brokerage service to match the health systems needs of developing countries with
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expertise in the UK. The Health Partnership Scheme is intended to run for four years in its initial
phase, from April 2011.


1.   Background to the Assignment

The UK has long experience of public health practitioners and institutions seeking to share
knowledge and expertise with counterparts in developing countries. These links have helped to
improve public health outcomes in some of the poorest countries in the world. They have also
provided a valuable opportunity for UK public health professionals to improve their skills in
challenging environments, offering a training and development route that directly benefits the
UK public health sector.

The Health Partnership Scheme, announced by the Prime Minister on 4 June 2010, will bring
together DFID-funded links activity, promoting effective partnerships between UK health
professionals, responding to the needs of institutions and counterparts in the developing world.
This links activity will improve health outcomes in developing countries and bring benefits to
the UK Public Health Sector by providing staff with training and development opportunities, and
introducing new ways of working into the UK.

The Health Partnership Scheme will focus primarily on people in most need concentrating on
DFID thematic priorities (reproductive, maternal, newborn health (RMNH), and malaria and the
management of fever) and on geographical areas defined as DFID priority countries1, in
particular in rural areas where health infrastructure is weakest. The multi-country partnerships
strand will be aimed primarily at delivering support to these themes/countries. The paired
institutional partnerships strand will be more open in terms of country or theme. Volunteering
opportunities could relate to either the multi-country partnerships strand or the paired
institutional partnerships strand, or alternatively, might be completely separate from either of
these as part of a stand-alone programme of volunteering with specific deliverables. To be clear,
we do not anticipate that the Health Partnership Scheme would fund generic volunteering
placements, only those with clear objectives and deliverables in line with the overall Health
Partnership Scheme aims and objectives. All applications will be judged on merit and potential
to support improved health services for the poorest. Given its nature, the Healthbay will also be
broad in scope to cover a range of health themes and geographical areas.

2.2     Interface with Stakeholders
Due to the number of interfaces required in the programme Service Provider will be expected to
develop and maintain collaborative relationships with a wide number of stakeholders. These will
include

DFID, including its UK-based offices, and its offices overseas
Department of Health
1
 As defined by DFID at the time bids for funding are considered, and taking into account the results of the
current DFID Bilateral Aid Review.


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National Health Service (at a national, regional, and institutional level)
Devolved Administrations
Royal Colleges and Deaneries
Tropical Health Education Trust
British Volunteer Advisory Liaison Group and associated organisations


In order to improve the efficiency of the overall removals process, the Service Provider will be
expected to participate in continuous improvement initiatives


2.4    Security Requirements
Due to the nature of the information being communicated between DFID and the Service
Provider, there will be a requirement for the safe and secure storage of DFID’s records, both in a
permanent location and during their transit, in accordance with prevailing government
guidelines.



2.5   Insurance Requirements
Respondents are advised that for this contract, there will be a minimum insurance requirement
of:

    1.   Professional Indemnity Insurance £5m limit of indemnity
    2.   Employers Insurance £10m limit of indemnity


2.6     Prevention of Illegal Working
Respondents’ attention is drawn to the requirement to comply with the Law on Prevention of
Illegal Migrant Working as set out in Section 15 – 25 of the Immigration and Nationality Act
2006 (which came into force on 29th February 2008 replacing the previous Section 8 of the
Asylum & Immigration Act 1996).




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3.       Procurement Process

DFID is following the Restricted Procedure of the Public Contracts Regulations 2006.

DFID reserves the right to reject any Respondent on the grounds of the ineligibility conditions
provided by Regulation 23 of the Public Contracts Regulations 2006.

DFID reserves the right to terminate the procurement process at any time and does not undertake
to award a Contract for the Services to any Respondent. In no circumstances shall DFID be
liable for any costs incurred by a Respondent in relation to the procurement process.

It is the intention that the procurement will take place in accordance with the methodology
outlined in the introduction to this PQQ. However, DFID reserves the right to change by notice
the basis of the procurement. It also reserves the right not to proceed with the proposed
procurement at all. Under no circumstances shall DFID or its staff, agents or advisors incur any
liability in respect of such matters.


4.       Conflicts of Interest

Respondents are responsible for ensuring that no conflicts of interest exist between Parties. In
particular this should include any conflict of interest between:
    ● advisors appointed by the Respondent and those appointed by DFID
    ● the Respondent and DFID or any Advisor to DFID

Any Respondent who fails to comply with this obligation could be disqualified from the
procurement process.


5.       Timetable

Responses to this Pre-Qualification Questionnaire must be received by e-mail at the address set
out in the OJEU Notice.
                               14:00 GMT on 29 December 2010

Responses received after this date and time may be disregarded.

The outline timetable for the remainder of the procurement is as follows:

     ●   OJEU Notice and PQQs issued               - 29 November 2010
     ●   PQQ final response time and date    - 14:00 GMT on 29 December 2010
     ●   ITT Issued                          - 17 January 2011
     ●   Submission of Bid                   - 21 February 2011
     ●   Bid Evaluations and internal Assurance    - From 22 February 2011
     ●   Contract Award                            - 21 March 2011
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    ● Service Commencement                     - 1 April 2011
DFID intends to let a contract(s) for a period of four years.




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6.      Instructions for Completion


Prospective Respondents should fully complete the PQQ below and return this document in its
entirety with all questions answered accurately and concisely. Where a question is not relevant to
your organisation, this should be marked N/A and an explanation given.

The format must not be altered and any supporting documents and information required by DFID
as part of the PQQ, e.g. copies of audited accounts, must be submitted as a separate attachment
and be clearly referenced commencing with the question number it relates to followed by a short
and clear description of the file content (e.g. Q1.12 Pen Portrait). All attachments must be
provided in formats compatible with the Microsoft Windows XP® operating system (*.doc,*.xls,
*ppt, *.pdf etc.). No single file should be more than 5MB in size.

All signatures should be submitted to DFID as a scanned copy of a version with an original ink
signature. An electronic/pre-scanned signature inserted into an electronic document will not be
accepted by DFID as a part of a compliant PQQ response.

Questions must be answered in English.

Responses will be evaluated in accordance with the procedures set out in Section 10. In the event
that none of the Responses are considered satisfactory, DFID reserves the right to consider
alternative procurement options or not to award a Contract. For the avoidance of doubt, DFID
will not bear any costs in respect of any abortive effort should no Contract be awarded.

Failure to furnish the required information, make a satisfactory response to any question, or
supply documentation referred to in responses, within the specified timescale, may mean that
Respondents will not be invited to participate further.


7.      Consortium and sub-contracting

Where a consortium or sub-contracting approach is proposed, all information requested should
be given in respect of the proposed prime contractor or consortium leader. Relevant information
should also be provided in respect of consortium members or sub-contractors who will play a
significant role in the delivery of services or products under any ensuing contract. Responses
must enable DFID to assess the suitability of the Respondent as a whole.

Where the proposed prime contractor is a special purpose vehicle or holding company,
information should be provided of the extent to which it will call upon the resources and
expertise of its members.

DFID recognises that arrangements in relation to consortia and sub-contracting may be subject to
future change. Respondents should therefore respond in the light of such arrangements as are
currently envisaged.
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DFID intends seeking independent financial, legal, market and internal advice and references to
validate information declared or to assist in the evaluation. References, site visits or
demonstrations and/or presentations may be requested at this stage.


8.      Queries about the procurement

DFID will not enter into detailed discussion of the Service requirements at this stage. Any
questions about the procurement should be submitted to Rachael McDougall at R-
McDougall@dfid.gov.uk.

If DFID considers any question or request for clarification to be of material significance, both
the query and the response will be communicated, in a suitably anonymous form, to all
Respondents who have expressed an interest.


9.      Supplier contact point

Respondents have been asked to include a single point of contact in their organisation for their
Response to the pre-qualification questionnaire. DFID shall not be responsible for contacting the
Respondent through any route other than the nominated contact. The Respondent must therefore
undertake to notify any changes relating to the contact promptly.


10.     Evaluation Approach

The objective of the selection process is to assess the Responses to the Pre-Qualification
Questionnaire and select potential Respondents to proceed to the next stage of the procurement.

Selection criteria will be a combination of both financial and non-financial factors and will be
carried out in two stages:

Stage 1 Evaluation will be applied in respect of the following questions, all of which are subject
to a pass/ fail test:



Question Question
reference

2.10        Acceptance that any anti-competitive behaviour, canvassing, collusion, or any
            attempt to distort the market in any way, could preclude your organisation from
            being a Supplier / Prime Contractor.

3.1         None of the grounds set out in The Public Contracts Regulations 2006 Regulation
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            23 apply

7.1         Negative answer to the questions: have any contracts been terminated for poor
            performance or has a court awarded any damages against the Respondent in the last
            five years?

9.2         Ability to supply the details to DFID to enable security clearance of staff

13.3        Negative response to the question: In the last 3 years, has any finding of unlawful
            discrimination in the employment field been made against your organisation by
            any court or tribunal or in comparable proceedings in any other jurisdiction?

13.4        1.     Negative response to the question: In the last 3 years, has your
                   organisation been or is in the process of being, the subject of formal
                   investigation by the Equality and Human Rights Commission on the
                   grounds of alleged unlawful discrimination in the employment field?



If a Respondent fails one of the categories noted above, the Response will be eliminated unless
the relevance and proportionality of the reason for failure is deemed by the Evaluation Panel to
be insignificant.




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Stage 2 Evaluation

This will be qualitative for the technical sections and both quantitative and qualitative for the
financial section. Weightings will be applied to each section as summarised in the table below,
with 1 being the least and 6 being the highest importance with a scoring mechanism of 0-6 being
applied to each response to the question, with 0 being the lowest and 6 being the maximum score
per question. A maximum weighted score of 264 is therefore possible to be achieved and only
Respondents who achieve a pass score of 195 will be invited to tender or a maximum of 5
suppliers with the highest score above the required pass mark.

Section                                         Weighting

1. Organisation Identity                             1

2. Organisation Information                          2

3. Compliance with EU Legislation                    2

4. Financial                                    Pass/Fail

5. Insurance                                         3

6. Relevant experience and references                5

7. Disputes                                          2

8. Areas of Business                                 2

9. Business Capability                               4

10. Professional Organisations                       1

11. Quality Assurance/ Health &                      2
Safety
12. Information Security                             3

13. Equal Opportunities                              3

14. Environmental Management                         2

15. Programme Specific Questions
                                                     12



11        Confidentiality and Publication of Information
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Any information provided by DFID within this PQQ document set, or in subsequent answers to
clarification questions from Respondents, is made available on condition that it is treated as
confidential (except where it is already in the public domain). Respondents must not disclose
any information supplied as part of this procurement process to any third party, member of staff
or advisor, unless such person needs to receive the relevant information for the purposes of
enabling a response to any procurement document.

Respondents who are selected to tender will be asked to sign and return the form of
Confidentiality Agreement and DFID terms and Conditions of Service which are attached at
Section 15 and 16 respectively, before they receive the ITT.

12      Freedom of Information and Environmental Information Regulations

The Freedom of Information Act 2000 (FOIA) and the Environmental Information Regulations
2004 (EIRs) provide statutory rights of access to information held by or on behalf of public
authorities under certain circumstances. DFID is obliged to meet its responsibilities under FOIA
and under the EIRs. As a consequence, any reports that DFID generates during the procurement
process may be disclosed in response to requests made under FOIA or under the EIRs.

If a Respondent considers that any of the information included in its Response to the PQQ is
commercially sensitive, the Respondent should identify it and detail: (i) (in broad terms) what
harm may result from disclosure if a request is received; and (ii) the time period applicable to
that commercial sensitivity. However, it should be noted that even where a Respondent has
indicated that information is commercially sensitive, DFID may still be required to disclose it
under FOIA. Also, DFID shall not be deemed to have accepted any duty of confidence by virtue
of receipt of any material marked 'confidential' or equivalent.

By submitting a PQQ for your organisation you agree to this information being securely held by
DFID in an electronic format and to DFIDs obligations under the above regulations.

13      Publicity

Respondents should not disclose or make available to the press, or in any other way make public,
any information in respect of this PQQ without the express written permission of DFID.


14      Reliance on Information

The information in this document and any other information provided by DFID is provided in
good faith. However, DFID (including its directors, officers, employees, agents or advisers)
does not give any warranty as to the accuracy or completeness of any information supplied.


15      Costs of the Procurement

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Respondents will remain responsible for all costs and expenses incurred by them, their staff, and
their advisors or by any third party acting under their instructions in connection with this PQQ.
This will be regardless of whether such costs arise as a result of any direct or indirect
amendments made to this PQQ by DFID at any time. For the avoidance of doubt, DFID shall
have no liability whatsoever to Respondents for the costs of any amendments, changes,
discussions or communications.

16      Collusion and Canvassing

Any attempt by an organisation, its staff, advisors or agents to influence the pre- qualification
process will result in its response being disqualified.

Direct or indirect canvassing by the organisation, its staff, advisors or agents in relation to this
PQQ, or any attempt to obtain information, on another Respondent or another PQQ submission,
from DFID, its officers, employees or their appointed advisors will result in disqualification.

17      Change of Control or Information Provided in the PQQ

Where a change in the structure, control, composition or membership of an organisation takes
place at any time prior to execution of the Contract, DFID must be informed of the change in
writing and DFID reserves the right to re-evaluate the relevant Respondent’s PQQ submission.

18.     Pre-Qualification Questionnaire
                                Application Questionnaire

The questionnaire is designed to enable DFID to verify the suitability of the Respondent to
carry out the Health Partnership Scheme. Part A requires the Respondent to complete a series
of questions concerning its organisation and Part B lists the documentation which Respondents
are required to submit together with the completed questionnaire.

This questionnaire will form the basis of a decision as to which suppliers to short-list to invite
for tender for the Contract. However, DFID reserves the right to request further information
and/or to visit the Respondent’s premises.

Respondents MUST provide ALL of the information requested below by the above date.
Failure to address any area may result in exclusion from the tender list.




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PART A - GENERAL INFORMATION


1.    ORGANISATION IDENTITY

1.1 Name of the organisation (Prime or Single              New Life
Contractor) in whose name the tender would be
submitted:
1.2 Lead contact name and job title:                    C.Peter Rex Charly, Managing Director
1.3 Address:                                            No.12-B, Athiyaman towers, 2nd Cross,
                                                        kambar Street, kumaran Nagar,
    Post Code :                                         Trichirapalli, Tamil nadu.
                                                        620017
1.4 Telephone number:                                   0431-2782726
1.5 E-mail address:                                     Newlife_elc@yahoo.com
1.6 Company Registration number:                        324/1993
1.7 Date of Registration:                               24.06.1993
1.8 Registered address if different from the above:     Door No.12-301,
                                                        Balaji Nilayam,
      Post Code :                                       Periyar Koil Street,
                                                        Chittoor -517001 (AP)
1.9 VAT Registration number:                            TIN NO 08601763925
                                                        VYOMIMPEX- A Partner/Sub-
                                                        contractor in our Consortium has a VAT
                                                        Registration number and this number is
                                                        given here.We are attaching the Copy of
                                                        the VAT Registration Certificate in
                                                        Annexure-1
1.10 Website address (if any):                          www.newlifemfi.org
1.11 Please advise the details of the Executive Directors/ Partners of your organization:
S.No. Name                                              Designation
1.      C.Peter Rex Charly                              President
2.      F.Beatrice Vanaja                               Secretary
3.      M.Gayathri                                      Treasurer
4.      R.Subburayan                                    Executive Committee Member
5.      S.Muthuraman                                    Executive Committee Member
6.      Mansoor Chetlu                                  Executive Committee Member
7.      A.Vijay Lourdu Nathan                           Executive Committee Member
1.12 Please provide a pen portrait with details and               Please see Annexure-2
experience of the senior management personnel
who will be responsible for implementation and
management of any awarded contract. Please limit

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your response to no more that 1 x A4 page using a
minimum of arial size 10 point font.



2.    ORGANISATION INFORMATION

2.1 Is your organisation:     i) a public limited                   iii) a sole trader?
                              company?
                              ii) a limited company?                iv) a partnership?   √
                              v) a statutory                        vi) a consortium
                              corporation
2.2 Where applicable, please                        Please see Annexure-3
provided a copy of your       We have attached copy of Registration Certificate of our
organisation’s Certificate of organization which is a Prime Contractor (partnering with other
Incorporation or similar.     organizations) that applies for this award by DFID.

2.3 Is your company a           N/A- Our organization is an independent legal structure and is
subsidiary of another           not a subsidiary of another company.
company?

If yes, please advise the
name and address of the
holding or parent company:

And the ultimate parent
company (if applicable)
including details of the
Parent Company’s
percentage holding.
2.4 Please provide a one-       Annexure -4 Organizational Chart enclosed. (The ownership of
page chart illustrating the     the organization is not individual but a collective body of
ownership structure of the      individuals)
Respondent including
relations to any parent or
other group or holding
companies.etc and include
as an attachment.
2.5 Please provide details of   N/A. There was no significant change in the ownership of the
any significant corporate       organization.
changes (e.g. changes in
ownership, etc) or
impending/future changes
since the last financial year
end.
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2.6 Is your organization:
a) Bidding to provide the
services required entirely on its                             NO
own?
b) Bidding in the role of Prime
Contractor and intends to use
                                                              YES
third parties to provide some
services?
c) Bidding in the role of a
                                                              NO
consortium?
2.7 If your answer to 2.6 is (b)
please identify intended
subcontractors / partners for the
bid below:
Subcontractors/Partners             Subcontractors/Partners
Organisation name                   Organisation address and contact details
UDAAN Society                       Gyanendra Mishra.,
                                    President,
                                    8/140, Raghuvirpuri.
                                    GT Road,
                                    Aligharh 02001.
                                    Uttarpradesh,India
                                    www.udaansociety.org
Jan Mitram Kalyan Samiti            Dr. M.G.Goswami
                                    President
                                    Jan Mitram House,Plot No 74,Kelo Vihar, Raigarh,
                                    Chattisgarh .,
                                    Phone – (07762)-220083,
                                             225234, 231148
                                    Fax-     220083
                                    Mobile- 098261-44243,
                                              094255-61501
                                    E-Mail: Janmitram@yahoo.co.in
                                    Website: www.janmitram.org
Kalpavriksh                         Sri Jeevan Sangram Das, Secretary, At: Amalapada,
                                    Po/Dist: - Phulpani, Khandhamala, Orissa.
                                    762001
                                    http://www.kalpavriksh.org/
                                    Mr. Vinay Kumar
VyomImpex                           5/267., Jaipur-302006,
                                    Rajasthan. 302020
                                    91-141-2786062
                                    91-141-2786061
                                    09462660053

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Solidarity of the Nation          Mr. Arjun Singh
                                  Bahar-B-10/32,
                                  Sahara Estates Jankipuram,
                                  Lucknow – 226021
                                  Uttarpradesh.,. India
                                  Phone : 0522-2735574,
                                  Mob- 09839367249, 09335907598
                                  www.solidaritynation.org
                                  info@solidaritynation.org
                                  awadhesh4@rediffmail.com
CRASA                             T.Yesupadam
                                  President
                                  # 21/519-7-3,
                                  Ashirvad Puram,
                                  Machilipatnam-521002,
                                  Krishna dist, Andra Pradesh,
                                   +91 8672 220128 (O)
                                   Mobile + 91 9441031089
                                  crasa_org@rediffmail.com,
                                  crasa.org@gmail.com
                                  www.crasa.org.in
SAI                               Ms.Mousumi Swain
                                  Dc.I , Head Office: At: Divine nagar,
                                  P.O: Nayabazar, District: Cuttack, Orissa, INDIA.
                                  Phone-0671-2442118,
                                  Fax-0671-2442118.
                                  Website: www.saiorissa.org.
                                  E-mail: sai_social@rediffmail.com,sai_social@yahoo.com.
KAGAS                             Dr. Ravish Joshi,
                                  Director,
                                  Mob No 9412095649
                                  Email: joshi_ravish@rediffmail.com
                                  1, Priya Sadan, Near Anand Hotel,
                                  Pithoragarh – 262501Uttarakhand (India)
                                  Tel: 91-05964-225265
                                  Fax: 91-05964-227246
                                  Email: kagas_in@yahoo.com
                                  Web. www.kagas.org
ADHAR,                            Umashankar Sahu, Executive At/P.O. Loisingha, Dist.
                                  Bolangir, Orissa, India,
                                  PIN: 767020
                                  Phone: +91 6653 274525
                                  E-mail: adharbolangir@gmail.com . info@adhar.in
MENNONITE BRETHREN                Rev.J.L.David, Executive Director,
DEVELOPMENT                       M.B. Medical Centre, Jadcherla, Dt.Mahabubnagar
ORGANISATION                      Andhra Pradesh 509302, India
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                                         Page   2 of 22


                                        Page 18 of 22
                                Office Address:
(MBDO)                          Mennonite Brethren Mission Compound,
                                Nagarkurnool, Dt. Mahabubnagar 509209
                                Andhra Pradesh, India
                                Office Telephone:
                                91-8540-225225, 225831
                                Cell –94410 49054
                                E-mail:mbdoindia@yahoo.com
                                davidjakkula@gmail.com

Apollo Tyres Foundation      Onkar S Kanwar
                             Chairman,
                             Apollo House
                             7 Institutional Area
                             Sector 32, Gurgaon 122001
                             Haryana, India
                             T:          +91 124 2721000
                             Website: www.apollotyres.com
Hyderabad – Karnataka center Smt. Aparna Kolla, Secretary No. 1-1168/3B, Near Old IT
for advanced learning and Office Building Aiwan- E- Shahi Road Gulbarga
welfare society (R) Gulbarga District : Gulbarga PIN : 585102
                             08472-256529 ; 9448333550; hkcglb966@rediffmail.com
SSKK                         Address:
                             26- Omnagar (3)
                             Behind GIDC,
                             Hanumanpara Road,
                             Amereli,
                             Gujarat- 365601
                             India
                             E-Mail: sskkamreli@gmail.com
                             Telephone: 02792223525
                             Fax: 02792223525
                             Mobile: 919427280028
                             Web: http://www.sskkamreli.org
MSUS                         MAHILA SAMAGRA UTTHAN SAMITI (MSUS)
                             DALTONGANJ
                             Professor Colony G.L.A College Road,
                             Daltonganj Palamau
                             Jharkhand
                             8221102
                             06562-240007 (O)
                             94311-93287 (M)
                             06562-235083 (Telefax)
                             msusindia@gmail.com
2.8 a) Have any of the       NO
Respondent’s directors,
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Date of Issue:     04/11/2010

                                      Page   2 of 22


                                      Page 18 of 22
partners, etc been disqualified
from acting as directors of any
company, under the provisions
of the Company Directors
Disqualification Act, 1986, or
equivalent host country
legislation, in the last five
years?
2.8 b) If the answer to question    N/A None of the Directors of the Prime Contractor nor the
2.8 a) above is yes, please         partner organizations Directors had been disqualified under
provide below a brief               the provisions of Company Directors Disqualification Act,
explanation of the details of the   1986.
relevant disqualifications.
2.9 Please give a brief outline     India is a very vast country with wide variations in culture,
on your policy regarding the use    language, behavioral pattern of people. In a development
of sub-contractors and, if          Project intervention, in order to bring a better representation
applicable, the extent to which     of all the regions of India, a consortium of NGOs who have
you might envisage using them       grassroots experience in executing and monitoring the
for this requirement. In            health projects were identified. These consortium members
particular, please indicate the     will have a distinct advantage in sourcing organizations to
nature of the relationship which    run the Health Partnership Scheme which focus primarily
you intend to create with the       on people in most need concentrating on DFID thematic
those third parties (including      priorities, in particular in rural areas where health
details of any previous             infrastructure is weakest.
collaboration with each) and the    The partners/sub-contractors of this consortium will
extent to which the relationships   identify the Volunteering opportunities of either the multi-
would be defined and governed       country partnerships strand or the paired institutional
in contracts or other forms of      partnerships strand, in their respective regions/ States
documentation e.g. collateral       allotted to them,
warranties.                         Our consortium with its partners located across Indian
                                    (North, North east, South and West) boundaries is better
                                    positioned to identify the meritorious and potential
                                    applications to receive the DFIDs support on improved
                                    health services for the poorest. .

                                    The monitoring and collection of reports from the respective
                                    regions/state is also the responsibility of our partners/Sub-
                                    contractors where as the consolidation and coordination at
                                    the national level and responsibility of reporting to DFID
                                    will be by the Leader of the consortium.

                                    Interface with Stakeholders
                                    Due to the number of interfaces required in the programme
                                    our partners in their respective region of jurisdiction will be
                                    expected to develop and maintain collaborative
                                    relationships with a wide number of stakeholders like
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                                            Page   2 of 22


                                           Page 18 of 22
                                  National Health Service (at , regional, and institutional
                                  level) where as our organization as Prime Contractor will
                                  collaborate with DFID and the National Health Service at
                                  the National level besides the other agencies like Devolved
                                  Administrations,Tropical Health Education Trust
                                  British Volunteer Advisory Liaison Group and associated
                                  organizations.
2.10 Do you acknowledge that      YES
any anticompetitive behavior,
collusion, or any attempt to
distort the market in any way,
could preclude your
organisation from being a
Supplier / Prime Contractor?
If NO, please give details and
outcome (continue on a separate
sheet if necessary)
2.11 Is your organisation an      NO. But our partner organization KALPAVRIKSH runs
existing supplier to DFID?        CLRC as associate partner of Orissa Watershed
If YES, please provide your       Development Mission
Supplier ID number below:         OWDM), NR International, & DFID implemented through
                                  the Soil Conservation Office,
                                  Kandhamal.

                                   Apollo Tyres Foundation in an active partnership with
                                  DFID had pioneered a corporate general health and
                                  STD/HIV intervention in Sanjay Gandhi Transport Nagar
                                  (SGTN) in the year 2000.
1.   Are there any conflicts of
     interest between
     ● the Respondent and         NO
         DFID or any Advisor to
         DFID?
     ● any advisors appointed     NO
         by the Respondent and
         those appointed by
         DFID
If the answer to 2.12 is YES,
please provide details.


3.    COMPLIANCE WITH EU LEGISLATION/UK PROCUREMENT LEGISLATION

1.   Do any of the circumstances as set out in                          YES.
     Regulation 23 Public Contracts Regulations            Vyomimpex member of our Consortium

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                                         Page 18 of 22
     2006 (from the EU) apply to your company?              has complied to the Regulations and the
     If YES, please supply details:                                 registration number is
                                                                      IN.CE,0029-07/07
DFID may seek evidence at a later date, in
confirmation of your answer.
(A summary of the circumstances of Regulation 23
is provided at the end of this questionnaire, Please
see Appendix 1)

4.    FINANCIAL (APPLICANT) and (Parent Company if applicable)

4.1 The following financial information is required to be provided.
(a) A copy of the most recent audited accounts YES           Our Organisations last 3 years
for your organisation that cover the last two                audited accounts (soft copies) for the
years of trading or for the period that is                   period ending 31.03.2010 is attached
available if trading for less than three years. As           in Annexure 3. The organizations
required by the Companies act, the latest of                 accounts statements include its
these accounts should be those that were filed               turnover, income and expenditure
a maximum of 10 months ago. This should                      accounts (since ours is a not for
include a statement of the organisation’s                    profit organization profit and loss
turnover, profit & loss and cash flow position               account will not be applicable) and
for the most recent full year of trading (or part            describes its cash flows position in
year if full year not applicable) and an end                 the Receipts and Payments statement
period balance sheet.                                        for the year 2009- 2010.
(c) If the organisation is a subsidiary of a
group, (a) and (b) are required for both the
subsidiary and the ultimate parent.
(d) A Parent company and/or a Performance           YES      If required by DFID we (the Primary
Bond may be required if considered                           Contractor) will enter and arrange a
appropriate. Is your organisation willing to                 Performance Bond or suitable
arrange for a suitable guarantee and/or a                    guarantee with our partner
performance bond if appropriate?                             organizations.
(e) Please provide the name and address of your YES          The Chief Manager.,
banker for the purposes of DFID obtaining a                  INDIAN OVERSEAS BANK.,
bank reference. (NB. DFID reserves the right to              11th Cross,THILLAINAGAR,
contact your bank for a reference. Your                      TRICHIRAPPALLI-620018
permission to do so will be assumed unless you               Tamilnadu,India
explicitly state any objections).                            Phone: 00-91-431-2740560
                                                             Mobile:00-91-9884414257
                                                             email:trthilblr@tri1sco.iobnet.co.in
4.2 Please give details of any event between       -NA-      Not Applicable. Our Organisation is
the date on which the latest set of accounts was             registered under Societies
authorised for issue and the date of the                     Registration Act, 1860. Under the
submission of this PQQ that, had the accounts                provisions of this act there is no
not been authorised for issue until the                      such thing involved between the

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                                           Page   2 of 22


                                          Page 18 of 22
submission date, would have required an                    latest set of accounts authorized and
adjustment or disclosure in accordance with                the date of submission of this PQQ.
the provisions of International Accounting
Standard 10.
4.3 Please give details of any significant        NO       There is no significant pending
pending developments, changes in financial                 developments, changes in financial
structure or ownership, prospective take-overs             structure or ownership, prospective
bids or buy outs which are currently in the                take-overs bids or buy outs which
public domain; copies of any company                       are currently in the public domain;
announcements made to the authorities of the               copies of any announcements made
stock exchange, market or bourse on which the              to the authorities of the stock
stocks or shares of the company are publicly               exchange, market or bourse on
traded, since the date of publication of the               which the stocks or shares of the
latest set of accounts.                                    company are publicly traded, since
                                                           the date of publication of the latest
                                                           set of accounts.


5.    INSURANCE
5.1 Please provide details of your organisation’s insurance protection.
Type                      Insurer                  Policy Number           Indemnity Value (£)
Employers Liability       NA                       We have so far not
                                                   covered the
                                                   Employers liability
                                                   however we will
                                                   cover this risk, if we
                                                   are assigned this
                                                   project by DFID.
Public Liability          1195                     Please see in           2202 lakhs.
                                                   Annexure - 5
Professional              NA                       We have so far not
Indemnity                                          covered the
                                                   Employers liability
                                                   however we will
                                                   cover this risk, if we
                                                   are assigned this
                                                   project by DFID
Other (please specify)
5. 2 Please provide details of any proposed subcontractor’s insurance protection.
Subcontractor
Type                      Insurer                  Policy Number           Indemnity Value (£)
Employers Liability       See Annexure -6(Janmithram )
Public Liability
Professional
Indemnity
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                                         Page 18 of 22
Other (please specify)


6.    RELEVANT EXPERIENCE AND REFERENCES

6.1 Please provide details of three major contracts you have been awarded for the provision
of services similar to those required by DFID during the last 3 years. In particular those
awarded by central government departments, agencies, local authorities, health authorities
NHS trusts or Global Aid Agencies. A4 continuation sheets may be appended where
required.
Customer name, Contact name and           Date         Service              Names of
address and e-      Telephone number contract          description and      subcontractors
mail                                      awarded,     size of              and/ or
                                          contract     organisation         consortium
                                          period and                        members and
                                          value of                          their role
                                          contract
Vyomimpex
BSF                 Director              15 lakhs     Border security      Ankit
                    general(purchase)                  force, India         suppliers,authris
                                                                            ed sub contractor
                                                                            for supply

BOC,India           Manager purchase          2 lakhs       Medical Oxygen   none
                                                            gas mfr and
                                                            supplier
                    Director Purchase
Pacific medica                                17.5 lakhs    medical          none
Pvt ltd                                                     eqiupments
                                                            exporter
JanMitram Kalyan Samiti
                                     Date of     Value of     Services           Name of
                                    Contract     Contracts    name and          Sub
                                    s                         description       contracts
 DRDA             Office of Zilla   2008.09       12695624.00 SGSY Spl           NIL
,Raigarh         Panchayat
                 ,Chote
                 Attarmuda
                 ,Raigarh
                 Ph no-
                 (07762)-
                 222032
                                    2009-10        8697760.00 SGSY Spl          NIL
                                    2009-10        1195050.00 BRGF lac          NIL
                                                              handicraft
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                                              Page 18 of 22
                                   2009-10           500000 BRGF Plan         NIL
                                                            ,Raigarh
                                   2010-11       1195050.00 BRGF lac          NIL
                                                            handicraft
                                   2010-11       3179000.00 SGSY shg          NIL
                                                            Training
                                   2010-11        615000.00 BRGF Lac          NIL
                                                            handicraft
                                                            tool kit
                                   2010-11          1603000 BRGF              NIL
                                                            livelihood
                                                            training
                                   2010-11        300000.00 BRGF Plan         NIL
                                                            ,Raigarh
 DRDA             Zilla            2009-10        449448.00 BRGF Plan         NIL
,Jashpur         Panchayat                                  ,jashpur
                 office
                 Jashpur Phone
                 –(07763)-
                 220617
                                   2010-11          443896.00 BRGF Plan       NIL
                                                              ,jashpur
 NABARD          Chhattisgarh    2008-09            249165.00 SHPI,SHG        NIL
,Raipur          regional Office                              Promotion
                 :-Pitholia
                 Complex
                 KK Road
                 ,Raipur (CG)
                 Tel –
                 (0771)2888499
                 ,
                 Email:-
                 nabrpr@mantr
                 afreenet.com
                                 2009-10            890147.00 RIF Lac         NIL
                                                              promotion
                                   2009-10          177458.00 SHPI            NIL
                                   2010-11           63750.00 SDP Training    NIL

 CGSACS          1ST Fllor         2008-09          427683.00    TI project   NIL
,Raipur          Health training                                (AIDs)
                 center ,campus
                 Kali BADI
                 Raipur (CG)
                 Phohe – 0771-
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Date of Issue:         04/11/2010

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                                             Page 18 of 22
                 2235807

                                 2009-10          387715.00 TI project        NIL
                                                            (AIDs)
                                 2010-11          671151.00 Targeted          NIL
                                                            intervation on
                                                            HIV AIDs
 FVTRS,Ba        Functional and 2008-09           133750.00 Skill training    NIL
ngalore          vocational                                 ,lac
                 Training
                 No-19,3rd cross
                 Hutchins Road
                 ,St Thomas
                 town post
                 ,Bangalore
                 Tel-91-80-
                 25460558
                 Email id-
                  fvtf@dataone.
                 in
                                 2009-10          133750.00 Skill training    NIL
                                                            ,lac handicraft
R-               SBI lead Bank   2010-11          120000.00 Training(mot      NIL
Seti,Raigarh     Office,                                    or binding )
                 Kelovihar
                 Raigarh.

SMPB,Raip         State        2009-10            100000.00   Aunla           NIL
ur               Medicinal                                    Campaign
                 Plant Board
                 Medical
                 College Road
                 ,Raipur (CG)
                 Phone -0771-
                 2522056
                 Email-
                 cgvanousadhob
                 oard@yahoo.c
                 o.in
                               2009-10            250000.00 Guggal            NIL
                                                            plantation
                                 2009-10           28000.00 School herbal     NIL
                                                            garden
                                 2010-11           85000.00 Aunla             NIL
                                                            campaign

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                                           Page 18 of 22
CAPART,B                           2008-09           492420.00 GVA(Awaren NIL
hubaneswar                                                     ess on water )
NMPB,,Ne          National      2009-10              500000.00 Awareness for NIL
w delhi          Medicinal                                     medicinal
                 Plant Board                                   promotion
                 Chandralok
                 Building ,36
                 Janpath ,New
                 delhi
                 Phone no- 011-
                 23315637
                 Fax:-
                 23319360
Janpad            Janpad Office 2008-09              167600.00 SHG Training   NIL
Panchayat        ,Raigarh
,Raigarh         Phone no – Ph
                 no- (07762)-
                 222032

                                   2010-11                   SHG
                                                     348800.00                NIL
                                                             Training
SHRC,             1ST Floor,       2008-09        1488750.00 Health           NIL
Raipur           State Health                                Promotion
                 training center
                 ,capus Kali
                 BADI Raipur
                 Phohe –
                 0771223617
                 Email
                 ID shrc.cg@g
                 mail.com
                                   2009-10        1140000.00 Health           NIL
                                                             Promotion
                                   2010-11        1774800.00 Health           NIL
                                                             Promotion
NAEB ,New Ministry of
Delhi     Environment
          and forest
          7th floor
          ,Paryavaran
          Bhawan ,New
          Delhi
          Phone no-011-
          24362457
                                    2008-09           79200.00 FDA            NIL

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                                              Page   2 of 22


                                              Page 18 of 22
                                                                          monitoring
BASICS           Indian                   2009-10                   73800 FDA                       NIL
India            Grameen                                                  monitoring
                 Services
                 CE-103
                 ,1ST FLOOR
                 ,SALT LAKE
                 CITY
                 ,KOLKATA
                 Phno – 033-
                 40055844
                                          2010-11               180600.00     Micro                 NIL
                                                                             finance
                                                                             Initiative
MADA              Rojgar                                                                            NIL
,Raigarh         Karyalaya
                 ,Raigarh
                 Phone no-
                 07762 223042

                  Divisional              2010-11               200000.00    Computer               NIL
 Forest          forest office                                               Training
Department       ,Raigarh(CG)
,Raigarh         Phone –
                 07762-224426
                                          2009-10               212700.00 Forest Micro              NIL
                                                                          plan &
                                                                          Training
No.     Project/ Programme                           District     Year      Name of Funding         Program
                                                                            Agency                  Stadus
1-      Community     Health      Initiatives   of   Champa       2005-     Skill           Share   Completed.
        KAGAS                                        wat          2006      International U.K.

2-      CBED (Community-Based           Economic     Champa       2002-     CECI- CIDA Canada       Completed.
        Development) Project                         wat          2005
3-      Swa-Shakti Programme                         Pithorag     2002-     Swa Shakti Govt. of     Completed.
                                                     arh          2005      Uttaranchal     and
                                                                            World Bank.
4-      Watershed      Conservation     and          Champa       2003      CAPART NewDelhi.        Completed.
        Development Project under CAPART             wat


5-      Small Poly House training program            Dist.        2001-     CAPART Lucknow          completed
                                                     Champa       2002
                                                     wat
6-      Carpet weaving training                      Dist.        2001-     Ministry of Textile     Completed.
                                                     Pithorag     2004      Govt. of India
                                                     arh
7-      Design workshop for Rambans                  District     2005-     Ministry of Textile     Completed.
                                                     Pithorag     2006      Govt. of India
                                                     arh

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                                                      Page 18 of 22
8-      Rambans Training                           Dist.        2005-        Ministry of Textile      Completed.
                                                   Pithorag     2006         Govt. of India
                                                   arh
9-      TSP(Total    sanitation    programme)      Pithorag     2004-        Swajal Project           Completed.
        Support by Swajal                          arh          2005

10-     Uttaranchal Community Health Initiative    U.S.         2003-        Action Aid India.        Completed.
        Supported by Action Aid India              Nagar        2004

11-     KOPAL Project                              U.S.Nag      2005-        Plan International/      On going.
        Supported by Plan      International   &   ar      &    continue     SBMA
        SBMA                                       Chmpaw
                                                   at
                                                   District
12-     Asha Plus Workers Training program         District     2007     -   Dept. of Medical         On going
        supported by dep of M.H & F. W.            Pithorag     continue     health and Family
        Uttarakhand                                arh                       welfare.

13-     Ajeevika Pariyojana                        District     2005     -   IFAD and Govt. of        On going
        Supported by Uttarakhand Government        Bagesh-      continue     Uttranchal.
                                                   War
14-     Room To Read Program Supported By          District     2005     -   Room to Read USA         On going
        Room To Read USA                           Bagesh-      continue
                                                   War
15-     UMANG Program Supported By Plan            District     2006     -   Plan International/      On going
      International and SBMA                       U.S.Nag      continue     SBMA
                                                   ar      &
                                                   Champ-
                                                   Awat
16-     Upliftment of SC community through         District     2007     -   Dept. of Science and     On going.
        technology intervention supported by       Champa       continue     Tech. Govt. of India
        Dept. of Science and Technology. Govt.     wat
        of India
17-     Indira Mahila Samekit Vikas Yojana         Dist.        2006     -   Govt. of Uttaranchal     On going
                                                   Pithorag     continue
                                                   arh
18-     Water and Sanitation program               Dist.        2007     -   Swajal Project Govt.     On going
                                                   Pithorag     continue     of Uttaranchal
                                                   arh
19-     Targeted Intervention Program              Pithorag     2009         Govt. of Uttarakhand     On Going.
        HIV/AIDS                                   arh                       and NACO

20-     RCH Program supported by Uttarakhand       Udhamsi      2009         Govt. of Uttrakhand      On going
        Government.                                ngh
                                                   Nager

21-     Adolescence Education Male/Female          Udhansi      2009         Govt. of uttrakhand      On going
        supported by Uttarakhand Government        ngh
                                                   Nager
22-     Room To Read Program Supported             District     2009         Room      to     Read    On going
        By Room To Read USA                        Nainital                  USA


7.    DISPUTES

7.1 Have you had any contracts which have been                                                   No
terminated for poor performance or has a court
has awarded any damages against the Respondent
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                                                    Page      2 of 22


                                                    Page 18 of 22
within the last 5 years?
If Yes, please provide details below:                                       -NA-
Customer name and           Contract reference and     Date of claim/        Reason for claim/
address                     brief description of       contract              contract termination
                            services provided          termination
                                                 -NIL-
 Has your organisation been involved in any court
action and/ or significant disputes (including                              -NIL-
employment tribunals) over the last 3 years?
If yes, please supply details:                                              -NA-
7.3 Are there any court actions and / or significant
disputes (including employment tribunals)                                   -NIL-
pending against your organisation?
If yes, please supply details:                                              -NA-

8.    AREAS OF BUSINESS

8.1 Please indicate below the principal areas of business activity of your company:

         S.No      Organisation Name                           Operational Area
         1.        UDAAN Society                               Uttarpradesh, North
                                                               India
         2         Jan Mitram Kalyan Samiti                    Chattisgarh, North
                                                               India
         3         Kalpavriksh                                 Orissa, East India
         4         VyomImpex                                   Rajasthan.West
                                                               India
         5         Solidarity of the Nation                    Uttarpradesh, North
                                                               India
         6         CRASA                                       Andra
                                                               Pradesh,South India
         7         SAI                                         Orissa, East India
         8         KAGAS                                       Uttarakhand, North
                                                               India
         9         ADHAR,                                      Orissa, East India
         10        MBDO                                        Andhra
                                                               Pradesh,South India
         11        Apollo Tyres Foundation                     Haryana,Central
                                                               India
         12        Hyderabad – Karnataka center for            Karnataka, South
                   advanced learning and welfare               India
                   society (R) Gulbarga
         13        SSKK                                        Gujarat, West India
         14        MSUS                                        Jharkhand

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                                              Page   2 of 22


                                           Page 18 of 22
9.     BUSINESS CAPABILITY

Year       The average numbers of staff who    The number of           Turnover (%)
           undertake similar work              managerial staff in
                                               post
           Permanent staff numbers:                    13                   3%
2007:      Third party staff numbers                  106                   7%
           Permanent staff numbers:                    16                   2%
2008:      Third party staff numbers                  153                   6%
           Permanent staff numbers:                    17                   2%
2009:      Third party staff numbers                  265                   5%
9.2All staff must be security cleared by DFID. Yes
Are you willing to supply details to DFID to
enable certification to take place?
9.3 Is there a code of discipline and behavior
for employees?
If Yes please supply a copy.

10.    PROFESSIONAL ORGANISATIONS

10.1 Please indicate      Indian School Finance Company (www.ifsc.org)
which professional or     Dasra-Financial, Advisory and Investment Services
trade bodies your         (www.dasra.org)
organisation belongs      TNCDW LTD, Govt of Tamilnadu (www.tamilnaduwomen.org)
to.                       Child Labour Eradication and Effective Rehabilitation
                          Society,(CHEERS)Collectorate,Trichirappalli -Under National
                          Child Labour Eradication Project,
                          (labour.nic.in/cwl/ChildLabour.htm - 2k)
                          DRDA, Trichrirappalli, Perambalur, Nagappattinam Districts
                          (www.angul.nic.in/drda.html )
                          ICICI Foundation for Inclusive Growth-
                          (www.icicifoundation.org)
                          Google Grant support- Adwords (www.google.org)
                          Give India (www.giveindia.org)
                          Centre for Social Initiative and Management (www.csim.org)
                          NPT+ Network For Positive People in Trichy (www.pwnplus.org)
                          United Nations-UN-Online Volunteering programme
                          (www.onlinevolunteering.org)
                          CSO Partners-( www.csopartners.org)
                          Tamilnadu Afforestration Project- Department of
                          Forests,Government of Tamilnadu (www.tn.gov.in)
                          Tamilnadu Prison Department,Govt of Tamilnadu
                          (www.tn.gov.in)

Issue No: 1
Date of Issue:       04/11/2010

                                          Page   2 of 22


                                          Page 18 of 22
                             National Committee for Promotion of Social,economic welfare,
                             Ministry of Finance, Government of India (www.nic.in)
                             IFMR Trust (www.ifmr.org)
                             State Bank of India (www.sbi.org)
                             ICICI Bank Limited (www.icicibank.org)
                             Oriental Bank of Commerce (www.obc.org)
                             Dhanalakshmi Bank Limited (www.dhanbank.org)
                             Institute of Rural Management,Anand. (www.irma.org)
                             National Institute of Public Cooperation and
                             Development,Regional Centre,Banglore (www.nipccd.org)
                             Centre for Microfinance (www.cmf.org)
                             APMAS(www.apmas.org)
                             Micro-credit summit campaign (www.cgap.in)
                             Bankers Institute of Rural Development (www.bird.org)
                             Indian Institute for Banking and Finance (www.iibf.org)
                             Planet Finance (www.planetfinance.org)
                             Governance of Indian Voluntary sector-
                             (www.governancecounts.org.in)
                             Grameen foundation - (www.grameenfoundation.org)
                             Credibility Alliance- Enhancing Accountability and Transparency
                             in Voluntary Sector (www.credibilityalliance.org)
                             Financial Management Service Foundation- (www.fmsindia.org)
                             Online resource base (www.infochangeindia.org)
                             Global Giving online donation platform (www.globalgiving.org)
10.2.      Is    your
organisation notified
under     the    Data
Protection Act 1998
(or         equivalent
national
legislation)? If so,
what is your DPA
notification number:


11.    QUALITY ASSURANCE/ HEALTH & SAFETY

11.1 Does your organisation hold any quality assurance                    YES
accreditations such as BS EN ISO9001 or equivalent standard?
If YES, please enclose a copy of the relevant accreditation certificate
11.2 Please provide details of any quality assurance certification for
which you have applied.
11.3 If your organisation does not hold a recognised quality assurance    YES
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Date of Issue:           04/11/2010

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                                            Page 18 of 22
certification, does your organisation have a quality management system
in place?
If YES, please provide details
11.4 Does your organisation have a written health and safety at work        YES
policy?
If YES, please provide a copy
11.5 Does your organisation have a health and safety at work system*?       YES
11.6 If ‘YES’ please provide details and if ‘NO’ to either 11.4 or 11.5
please explain why :
11.7 Has your organisation been issued with any enforcement or              NO
prohibition notices by H&S Exec in the last 3 years?
If answered ‘YES’, please provide details


Notes:
      ●   “System” means processes and procedures to ensure that the subject is properly
          managed. This includes making sure that legal requirements are met.


12.       INFORMATION SECURITY

12.1 Please provide details of security measures to ensure the safe keeping of any paper or
computerised information provided by DFID, both in storage and in transit, in accordance
with current government guidelines
12.2 Please submit a statement of security principles and procedures for your staff.


1.        EQUAL OPPORTUNITIES/EQUALITY AND DIVERSITY

13.1    Is it your policy as an employer to comply with the 2010 Equality Act
       in relation to decisions to recruit, train, promote employees and foster
       good relations across the strands below:
        Age                                                                            YES
      Disability                                                                       YES
      Gender                                                                           YES
      Gender reassignment                                                              YES
      Race                                                                             YES
      Religion or belief                                                               YES
      Sexual orientation                                                               YES
If yes, please provide your companies policies.
13.2 Does your organisation have an equality and diversity policy?
       If yes, please provide your policy document.                                    YES
13.3 In the last 3 years, has any finding of unlawful discrimination in the
        employment field been made against your organisation by any court                  NO
or      Tribunal or in comparable proceedings in any other jurisdiction?
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Date of Issue:         04/11/2010

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                                           Page 18 of 22
2.      In the last 3 years, has your organisation been or is in the process of
        being, the subject of formal investigation by the Equality and Human          NO
        Rights Commission on the grounds of alleged unlawful
        discrimination in the employment field?
3.      If the answer to question 13.3 or 13.4 is Yes, what steps have you
        taken as a result of that finding or investigation?


2.    ENVIRONMENTAL MANAGEMENT

1.    Does your organisation hold any Environmental Management
      accreditations such as BS EN ISO14001?                                          NO
      If YES, please provide copy certificates.
2.    Please provide details of any environmental management certification           -NA-
      for which you have applied?
3.    Does your organisation have an Environmental Management
      System?* If YES, Please supply details                                       YES/NO
14.4 Please provide a copy of your companies Environmental policy

*System means processes and procedures to ensure that the subject is properly managed. This
includes making sure that legal requirements are met.



2.    HEALTH PARTNERSHIP SCHEME SPECIFIC QUESTIONS

      NB - Please attach answers to these questions as a separate attachment

15.1 Please provide examples of track record of managing projects aimed at improving health
systems in low-income countries.
15.2. Please provide examples of track record of working with the UK health sector to deliver
development projects.
15.3 Please provide examples of managing volunteering schemes.


PART B-ENCLOSURES
Please check that you have enclosed the following supporting documents with your completed
questionnaire:
 SECTION QUESTION                     DOCUMENT                 ENCLOSED       File Name
    1         1.12     Pen Portraits of senior management        YES         Annexure - A
                       personnel
    2          2.2     Certificate of Incorporation              YES          Annexure-3
    2          2.4     Ownership Structure chart                 YES          Annexure-4
    4        4.1(a)    Copy of most recent audited accounts      YES
                                                                             Annexure - B
                       to cover last two years of trading
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Date of Issue:        04/11/2010

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                                           Page 18 of 22
    4            4.1(b)    Statement of the organisation’s cash
                           flow forecast for the current year and
                           a bank letter outlining the current cash
                           and credit facility position
    4             4.3      Copies of any companies                      NO
                           announcements
    6             6.1      Continuation of description of three         YES      Annexure - C
                           major contracts
     6            6.2      Performance details                          YES      Annexure-D
     6            6.3      Service Improvement details                  YES      Annexure-E
    11           11.1      Quality Assurance certification              YES      Annexure-F
    11           11.3      Details of Health and Safety at work         NO
                           systems
    11        11.4         Health and Safety at work policy           YES / NO
    12       12.1 &        Details of security measures,              YES / NO
              12.2         principles and procedures
    13        13.1         Equality Policies on Age, Disability,        YES      Annexure-G
                           Gender, Gender Reassignment, Race,
                           Religion or Belief, Sexual Orientation
    13           13.2      Equality and Diversity Policy                YES      Annexure-H
    14           14.1      Environmental Management                   YES / NO
                           Accreditations
    14           14.3      Details of Environmental                   YES / NO
                           Management System
    14           14.4      Environmental Policy                       YES / NO   Annexure-I
    15           All       Programme Specific Questions                 YES      Annexure-7


Form completed by:

Name: …… …………………                          Tel No: ………………………………

Signature: …………………..……………………… Date: …………………………………

Position: …… ……………….…… E-mail: ………………………………

Thank you for completing this questionnaire. The information it contains will be held in
confidence by DFID and used for the purpose of determining your suitability for meeting our
general requirements for the provision of the Services. Further assessment may be required
before any indication can be given on the success of your tender.

COMMENTS



Issue No: 1
Date of Issue:            04/11/2010

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                                              Page 18 of 22
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Date of Issue:   04/11/2010

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                                                                                        APPENDIX 1


DISCLAIMER

SUMMARY OF INELIGIBILITY CONDITIONS PROVIDED BY REGULATION 23 OF THE
PUBLIC CONTRACTS REGULATIONS 2006

Regulation 23 sets out the grounds on which a service provider may be deemed ineligible to
tender for, or be awarded a public contract. A summary is provided below. However,
Respondents should obtain their own legal advice on this area. The Regulations are available at
http://www.opsi.gov.uk/si/si2006/20060005.htm

Rejection is permissible when a service provider:

- guilty of conspiracy, corruption, bribery, fraud or money laundering. Rejection is also
permissible where any of the directors or other significant decision makers are guilty of any of
these offences;

- is in a state of bankruptcy, insolvency, compulsory winding up, administration, receivership,
composition with creditors or any analogous state, or subject to relevant proceedings;

- has been convicted of a criminal offence related to business or professional conduct;

- has committed an act of grave misconduct in the course of business;

- has not fulfilled obligations relating to payment of social security contributions;

- has not fulfilled obligations relating to payment of taxes;

- is guilty of serious misrepresentation in supplying information required by DFID under the
Regulations;

- is not in possession of a relevant license or is not a member of the appropriate organisation
where the law of that State requires it) or is not registered on the relevant professional or trade
register of the relevant State in which established.




Issue No: 1
Date of Issue:        04/11/2010

                                            Page   2 of 22


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