Government Wireless Network Project: Appendix A: Respondent and by 03QBq0

VIEWS: 11 PAGES: 2

									Appendix A                      Respondent and Participants Details
Respondents should complete the tables below for the Respondent and each Participant.
Respondent / Participant Details

Respondent / Participant Name

Project role


Registered Office Address



Principal Place of Business
Address


Date and Place of Incorporation

Trading and Business Names

Registered Business Number

Australian Business Number

Registered for GST? (please
                                                   Yes                       No
circle)

Office Hours                          Week days                  Emergency after hours


Website



Contact Details
Contact Name

Position

Address

                                      Office
Contact Telephone
                                      Mobile
Fax Number

Email



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
        authority; and

       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

								
To top