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Pre-qualification questionnaire



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INTRODUCTION Within the East Surrey area, four (4) Councils are joining together to tender for the provision of Mailing and Printing of Annual Billing. These Councils are Epsom and Ewell Borough Council, Mole Valley District Council, Reigate and Banstead Borough Council and Tandridge District Council. The Contract for Mailing and Printing of Annual Billing will include Council Tax bills, Business Rates and Benefits. This contract will be tendered under the “restricted” procedure and the Councils are seeking expressions of interest from companies wishing to provide these services in order to pre-qualify for the tender documents. The completion of this questionnaire is necessary to assess a Contractor’s suitability to perform the services under consideration. The Councils are seeking to appoint a contractor for the services outlined below for a period of 3 years with the first services required to be completed in early 2007. Brief description of works to be included: This service will include the personalised printing of council tax bills for approximately 153,000 households, and 10,500 business rate properties and the printing of benefit notifications for approximately 21,000 benefit claimants and landlords and the associated leaflets, booklets and payment books, across the 4 authorities. The matching of bills, payment books, benefit notifications and relevant leaflets will be required prior to despatch. It will be imperative to meet the strict deadline for despatch of bills and associated documents set by each Council 1. Guidance Notes Please note the term "applicant" refers to sole proprietor, partnership, Limited Company, Cooperative or as appropriate. The undertaking should be signed by the applicant, a partner or authorised representative in her/his own name and on behalf of the applicant. Please answer the questions specifically for your Company and not for the Group where your Company is part of a group of Companies. Applicants must complete the whole Questionnaire. Failure to do so may result in your exclusion from the Select list of Tenderers. The Questionnaire will be used to evaluate the Applicant’s suitability for inclusion on a Select Tender List. Contractors included in such a list will be requested to submit competitive bids for the contract in question. Applicants should include, where appropriate, any supporting documents marking clearly on all enclosures the applicant's name and the number of the question to which they refer. Where a question is not applicable, the applicant should write "NOT APPLICABLE".

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Procedures for the letting and regulation of the Contract will be in accordance with the Council's current Standing Orders and any appropriate Domestic and European Legislation and Directives. The provisional timetable for the procurement process is as follows; This questionnaire, when fully completed, together with any supporting documentation must be returned in hard copy no later than 25th July 2006. (electronic copies will not be accepted) To the Council:Epsom & Ewell Borough Council Town Hall The Parade Epsom Surrey KT18 5BY For the Attention of: Lynette Moss Email:

2. Information Relating to Applicant Full name of applicant (if a partnership, the full name of each partner must be given)

Business address (for correspondence)

In the case of a Limited Company, Registered Office (if different from above)

Person signing application on behalf of the Firm

Designation of person named in 2.4

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Telephone number of applicant

Is the applicant a sole trader, partnership, Private or Public Limited Company or other (please specify)

Have any of the Directors, Partners or Associates been in any Organisation which has been liquidated or gone into receivership? (If so, give details) Yes No

Has any Director, Partner or Associate ever been employed by any of the Councils listed? (If so, give details) Yes No

Please state if any Director, Partner or Associate has a relative(s) who is or was employed by any of the Councils listed as an Officer or is or was a District Councillor

If a Limited Company state the applicant's date of registration and registration number DATE REGISTRATION NUMBER

Please enclose a copy of the Certificate of Incorporation of the Applicant under Section 13 of the Companies Act 1948/1985 and any Certificate of Change of Names (if applicable). Please tick if enclosed If the applicant is a member of a group of companies, give the names and addresses of the ultimate holding company and all other subsidiaries. Please also provide a Structure Diagram to illustrate the relationships.

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If your Company is a member of a Group / Joint Venture, has another Group/Joint Venture member applied for this Contract? If yes please provide details. Yes No

Would the group or the ultimate holding company be prepared to guarantee the applicant's contract performance as its subsidiary? (Tick as appropriate) Yes No

Please confirm that the objects of the Applicant, as set out in the Memorandum of Association provide for it to carry out contracts of the type applied for. Yes No

3. Financial Information, including Insurance Who in the applicant’s organisation is responsible for financial matters? Name _______________________ Position ________________________ Tel No _____________________ Address _______________________

Copies of audited accounts and annual reports for the last 2 years should be enclosed, to include:Balance sheets Full notes to the Accounts Please tick if enclosed Profit and Loss Accounts Director's Report/Auditor's Report

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Details of any outstanding claims or litigations against the applicant, if any. If none state NONE


Please list details (Policy number, company, value, expiry date) of relevant insurance policies (e.g. public liability, professional indemnity, motor) held:

4. References 4.1 Please give details of all relevant contracts undertaken in the past 3 years in the table below. (please expand table if required) We reserve the right to contact any of these clients for reference purposes.
Approx Annual Value Reference Contact Details Referee Telephone No

Contract Name and Brief Description


Reference Name

Contract Name and Brief Description


Approx Annual Value

Reference Name

Reference Contact Details

Referee Telephone No

Contract Name and Brief Description


Approx Annual Value

Reference Name

Reference Contact Details

Referee Telephone No

N.B References must include the following information: 6 of 15

 Details and evidence of Billing Experience  Details and evidence of any experience of working with consortium arrangements or multiple partners  Details and evidence of contract volumes and timescales

5. Technical and Management Resources State the address from which the Contract with the Council would be controlled:-

State the address from which the Contract with the Council would operate (if different from above):-

Has the applicant ever suffered a deduction for liquidation and ascertained damages in respect of any Contract within the last 3 years? If yes please provide details. Yes No

Has the applicant ever had a Contract terminated or had its employment determined under the terms of a Contract? If yes please provide details. Yes No

If the answer is YES to any of the questions 5.3 to 5.4 above, further details should be enclosed on separate sheet(s). This contract will require the manipulation of Data Files. Please confirm that you are able to handle this requirement.

6. Health and Safety Name and address of the Director, Partner or other person responsible for the implementation of the applicant's Health and Safety Policy

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Name: __________________________________________________________ Position: ________________________________________________________ Address: ________________________________________________________

Please detail how the above ensures the implementation of the Policy.


Applicants must provide a copy of their written Health and Safety Policy Statement (as required by Section. 2(3) of the Health and Safety at Work Act 1974. Have any notices been served by the Health and Safety Executive or any Local Authority Enforcement Officer in the last 3 years? If YES please give details and outcome. Yes No


7. Equal Opportunities Do you as an employer comply with your statutory obligations under the Race Relations Act 1976? Yes No

Accordingly, is it your practice not to treat one person less favourably than another because of colour, race, nationality, ethnic origin, sex, age, religious and political beliefs, in relation to decisions to recruit, train or promote employees? Yes No

In the last 3 years, has any finding of unlawful discrimination been made against the applicant by any Court or Industrial Tribunal? If YES, give details Yes No 8 of 15


In the last 3 years, has the applicant been subject to any formal investigation by the Commission for Racial Equality on the grounds of alleged unlawful discrimination? If YES, give details. Yes No


Do you undertake to provide information and access to such documents as the Council may require to enable it to satisfy itself that your company complies and will continue to comply with the Race Relations Act 1976? Yes No

8. Quality Assurance Is your company presently operating a site(s) which has achieved ISO 9000? If YES, which site(s)? Yes No

If YES, has the whole or part of the operation achieved ISO 9000? If part, which part, please give details. Whole Part

ISO 9000 registration number(s):-

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If you have no ISO accreditation, please outline what quality management arrangements are in place?

9. Environmental Policies Epsom & Ewell Borough Council is encouraging Contractors to review their operations to ensure they have minimal negative impact on the environment, in local, national and global terms. 9.1 If your Company is working towards the standards of ISO14000 series or EMAS accreditation or is using another Environmental Management Systems (EMS) please provide appropriate details. Proposals should also be included of how the standards will be transferred to Epsom & Ewell Borough Council Contract areas.


Does your Company have an environmental policy? If YES, please enclose copy to support this Yes No Please tick if enclosed

9.3 If NO, please indicate if you have taken any initiatives in the following areas:Theme Energy Water Transport Waste Examples of initiatives Setting targets to reduce the Company's energy usage Setting targets to reduce the Company's water usage Introducing fuel efficiencies in the fleet and reducing vehicle pollution Reducing and salvaging waste products, complying with the Duty of Care Regulations Yes No

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Purchasing Staff Improving the quality of the local environment Other

Ensuring products and materials used are environmentally friendly Ensuring staff fully contribute to help implement environmental initiatives Measures to reduce pollution or improve landscape / wildlife quality Please specify and include further details …………………………………………………… …………………………………………………… ……………………………………………………


Where you have ticked YES please provide details of activities undertaken. Please tick if enclosed

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10. Declaration After completion of the Questionnaire, please read the following and complete article 10.9 (final) below. Please ensure that when you return the Questionnaire that all information that has been asked of the Applicant in support of this application has also been enclosed. Any supporting documents should be marked clearly with the Applicant’s Name and the number of the Question to which they refer. NO part of this Application form or details supplied to the Authority can be returned to the Applicant. 10.1 The Applicant agrees that the Council reserves the right to make final selection from the Applications received. 10.2 The Applicant agrees that the statements contained within the application are accurate and that any entry therein which is falsely made shall be justification for my/our exclusion from the selected Tender List. 10.3 The Applicant agrees that in the event of there being any uncertainty as to the intention of any portion of this document, particulars of such uncertainty shall be referred to the Council, in writing, for clarification. 10.4 The Applicant agrees that canvassing in any manner whatsoever shall be justification for this exclusion from the selected Tender List. 10.5 The Applicant agrees that should this application be successful that his/her name(s) may be included within a Tender List. 10.6 The Applicant understands that it is a criminal offence, punishable by imprisonment, to give or offer any gift or consideration whatsoever, as an inducement or reward to any servant of a public body and that any such action may empower the Council to cancel any Contract in force and will result in the Applicant’s exclusion from any Select List of Tenderers the Council may have. 10.7 The Council may take up some or all References. In certain instances it may be necessary for the Applicant to provide additional Referees should the Council decide it is appropriate to do so. The Applicant will be advised in writing. The Applicant agrees to provide further information as to Referees where necessary to aid in the analysis of this Questionnaire. The Applicant agrees that this Questionnaire may be followed-up by the Council Officers or by its engaged consultant by means of interview. 10.8 The Applicant certifies that s/he has read the whole of the foregoing and that the answers to the Questionnaire and accompanying information are a true and accurate response.

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Applicant Name: Signature*: For and on behalf of: Date: ……………………………………………………. …………………………………………………… …………………………………………………… ……………………………………………… 2004

Witness I hereby witness the signature of the Applicant and that the signature is his usual signature and to the best of my knowledge is authorised on behalf of the Company to complete this Questionnaire. Witness: Designation: ……………………………………………………………… ………………………………………………………………


To be signed by the Applicant of a Company or Incorporated Company, by a Partner of authorised representative respectively in his own name, and on behalf of such Company or Incorporated Company in presence of a witness. A witness must countersign this document.

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