Appendix A Respondent and Participants Details
Respondents should complete the tables below for the Respondent and each Participant.
Respondent / Participant Details
Respondent / Participant Name
Registered Office Address
Principal Place of Business
Date and Place of Incorporation
Trading and Business Names
Registered Business Number
Australian Business Number
Registered for GST? (please
Office Hours Week days Emergency after hours
Government Wireless Network Project – Appendix A 1
Each of the above Respondent and Participants:
accept, and agree to comply with the terms and conditions of, the EOI Invitation; and
acknowledge that the State is relying on each of the Respondent's and its Participants'
acceptance of and agreement to comply with the EOI Invitation in allowing them to participate in
the EOI process and any other Project Procurement Process.
Signed for [INSERT RESPONDENT], on its
behalf and on the behalf of each Participant,
by its authorised representative in the
presence of: Authorised Representative Signature
Witness Signature Authorised Representative Name(print)
Witness Name (print) Authorised Representative Position
By signing the above:
the authorised representative warrants it has the authority to sign this document on behalf of the
Respondent and each Participant and has no knowledge of any revocation or change to such
the Respondent warrants it has authority to sign this document on behalf of each Participant and
has no knowledge of any revocation or change to such authority.
Government Wireless Network Project – Appendix A 2