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Qualification Questionnaire

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					Qualification Questionnaire

  Introduction
  To enable the Council to assess your company's suitability to become a prospective
  contractor, it requires all the information outlined in this application form.
  Failure to complete the form in full or to provide any of the documents requested may
  result in your application being rejected. All responses and submissions provided by the
  applicant will form part of the contract should the applicant subsequently be successful.
  Information provided in this document will form a part of the assessment for the award of the
  Emergency Home Based Respite service contract.
  Where insufficient space has been provided in this document, the applicant may append
  additional pages.
  Prospective bidders should be aware that canvassing will lead to disqualification.
  Any information and/or documents submitted in response to this questionnaire must
  relate to the applicant only.
  The applicant is the organisation which it is proposed will enter into a formal contract with
  the Council if awarded the contract.



                 1   INFORMATION ABOUT THE FIRM
                 2   STATUS OF APPLICANT
                 3   FINANCIAL MATTERS
                 4   INSURANCE
                 5   EQUAL OPPORTUNITIES
                 6   HEALTH AND SAFETY
                 7   CONTRACT PERFORMANCE AND QUALITY MANAGEMENT
                 8   BUSINESS STRUCTURE
                 9   MANAGEMENT STRUCTURE
                 1
                 0   RESOURCES
                 1
                 1   STAFF TRAINING
                 1
                 2   QUALITY ASSURANCE
                 1
                 3   LEGAL PROCEEDINGS
                 1
                 4   PARENT COMPANY AND GURANTEES
                 1
                 5   FINANCIAL AND ECONOMIC INFORMATION
                 1
                 6   REFERENCES
                 1
                 7   DECLARATION
 Qualification Questionnaire


1.
            INFORMATION ABOUT THE FIRM


     1.1.
            Registered name of firm making the application



     1.2.
            Address of registered office



            Telephone Number:


            Fax Number:


            E-Mail:


     1.3.
            Address for correspondence relating to this application



            Telephone number:


            Fax number:


            E-mail:


     1.4.
            Details of the person who completed the form



            Name:


            Position:


            Telephone number:
Fax number:


E-mail:
2.
             STATUS OF APPLICANT

     2.1.
             Is the applicant:

     2.2.
             (a)     A sole trader?                                                     Yes/No
     2.3.
             (b)     A partnership?                                                     Yes/No
     2.4.
             (c)     A limited company?                                                 Yes/No
     2.5.
             (d)     A public limited company?                                          Yes/No
     2.6.
             (e)     A local authority DSO?                                             Yes/No
     2.7.            A charity:
             (f)
                     Trading as a company?                                              Yes/No
                     Or
                     Number of trustees if not a company?                               Yes/No
     2.8.    (g)     Other – please specify
                                                                                        Yes/No

     2.9.
             Date of formation or registration:

     2.10.
             Registration number (if any) and registered address:

     2.11.
             Please enclose a copy of the Company Certificate of Incorporation (if      Enclosed
             applicable) and any certificate of incorporation on change of name.

     2.12.
             VAT Number:

     2.13.
             Are you applying to be considered for award of the contract under a         Yes/No
             different name?

             If yes, please list the name(s) of the other trading company(ies)



     2.14. Is the organisation that is bidding the same as the one that is going to
           deliver the service?

             If not, please state the name of the organisation that would deliver the
             service
  2.
               STATUS OF APPLICANT

       2.15.
               If your organisation is a limited company, please list the names of the firm‟s directors
               (use an extra sheet if necessary)

               If not a limited company, list members of the Management Board, Partners,
               Associates etc. that are responsible for the activities of the firm




STATUS OF APPLICANT (Continued)

       2.16.
               Have any of those listed in 2.14 or company secretary:


               Interests in any other companies                                         Yes /No


               Been the subject of a bankruptcy order or been involved in any firm
               which has ceased to trade or become insolvent as defined by the          Yes /No
               Insolvency Act 1986


               Been employed within the last three years at a senior level by this
                                                                                        Yes /No
               Council or served as a Councillor or been involved with any other
               company providing any service to the Council


               If yes to any of these please provide details:




       2.17. If you are a member of a group of companies, please list all related companies
             within the group:


                             Company Name                        Relationship




       2.18.
               Are you registered with CSCI/CQC to provide domiciliary care             Yes /No
               services?
                                                                   Enclosed
If yes, please provide a list of CSCI/CQC registered domiciliary
care services provided by your organisation.
3.
            FINANCIAL MATTERS

     3.1.
            Please supply the audited accounts for the last three of its financial years (or
            for the period of the applicant's incorporation if a company or of the
            applicant's trading if a partnership or sole trader, if such period be less than          Enclosed
            three years). The accounts submitted must relate solely to the applicant.

     3.2.
            If you cannot provide the information requested in 3.1 please say why and
            give the best alternative financial information you can such as:

            A certified statement of turnover for the last year, signed by an independent
            auditor of bank manager
                                                                                                      Enclosed
            Copies of internal management accounts of business plan.

     3.3. Please provide details of the published figures for the three previous financial years for:




                                                                    Year        Year           Year


             Applicant‟s Company Turnover



             Turnover Specific to this activity




     3.4.
            If the applicant is called upon to provide a bond, who will provide a surety (e.g. bank or
            insurance company)?

            Name:

            Address:
4.
            INSURANCE

     4.1.
            Please provide details of all insurance cover currently in force. If your company‟s
            quote is successful, adequate insurance cover will be required. The levels are
            indicated below. If your current insurance is insufficient, please enclose a copy of a
            quotation from your insurance company indicating that the increased cover will be
            available should you be awarded the contract.

            Please complete details and indicate the level of cover you have including details of
            the issuing company, policy number, cover provided and renewal date (and provide
            confirmation from your broker).
     4.2.


                                          Insurer         Policy No.      Cover £         Renewal
                                                                                           Date
             Public Liability
             (min £10m cover)
             Employer‟s Liability
             (min £10m cover)
             Professional
             Indemnity (min £1m
             cover)
             Fidelity Guarantee
             (min £250k cover)


     4.3. Are there any outstanding insurance claims against you (other than routine                 Yes/No
          employment cases)? Please list as appropriate.
5.
            EQUAL OPPORTUNITIES




     5.1. Walsall Council is a member of the West Midlands Forum which            Enclosed
          operates a Racial Equality Common Standard for Council
          Contracts. Other member authorities include Coventry City
          Council, Redditch Borough Council, Birmingham City Council,
          Sandwell Metropolitan Borough Council and Wolverhampton
          City Council.


            If your Racial Equality in Employment (Equal Opportunities)
            Policy has been approved by one of the member authorities,
            please supply a copy of the letter of accreditation.


            If your firm does not currently operate in the UK, you should still
            try to answer each question, substituting any law, code of
            practice etc that is appropriate to your domestic jurisdiction.


     5.2.                                                                         Number:
            Please state the number of direct employees in your company
            (including directors, partners etc)


            Sole proprietors need not complete this section. For the purposes of this
            section only, a sole proprietor is defined as a company/firm who does not
            employ family, staff, subcontractors or other sole proprietors.


            Questions 5.2 to 5.5 are questions and descriptions of evidence prescribed
            by the Secretary of State in respect of section 18 (5) of the Local
            government Act 1988
     5.3.
            Is it your policy as an employer to comply with your statutory
            obligations under the Race Relations Act 1976 and accordingly,
            your practice not to treat one group of people less favourably
            that others because of their colour, race, nationality or ethnic
            origin in relation to decisions to recruit, train or promote             Yes/No
            employees?


     5.4.
            In the last three years, has any finding of unlawful discrimination      Yes/No
            been made against your organisation by any court or industrial
            and/or employment tribunal?
5.5.
       In the last three years, has your organisation been the subject of
       formal investigation by the Commission for Racial Equality on         Yes/No
       grounds of alleged unlawful discrimination?


5.6.
       If the answer is in the affirmative or, in relation to the question
       the Commission made a finding adverse to your organisation,           Yes/No

       What steps did you take in consequence of that finding
EQUAL OPPORTUNITIES (CONTINUED)




            Firms with fewer than five persons need not complete this question, but
            must give a written assurance that they will provide an equal
            opportunities policy should the size of the firm increase.


    5.7.
            Is your policy on race relations set out:


            In instruction to those concerned with recruitment, training and   Yes/No
            promotion?

    5.8.
            In documents available to employees, recognised trade              Yes/No
            unions or other representative groups of employees?


    5.9.    In recruitment advertisements or other literature?                 Yes/No


    5.10. Please supply relevant examples of the instructions,
          documents, recruitment advertisements or other literature.           Enclosed

            (this information may be in your Equal Opportunities Policy
            (Race Relations)


    5.11.
            Do you observe as far as possible the Commission for Racial
            Equality‟s Code of Practice for Employment, as approved by
            Parliament in 1983 which gives practical guidance to
            employers and others on the elimination of racial
            discrimination and the promotion of equality of opportunity in
            employment, including the steps that can be taken to
            encourage members of the ethnic minorities to apply for jobs
                                                                               Yes/No
            or take up training opportunities?


    5.12. We seek to ensure that all sections of the community have access to our
          services. We also wish businesses from all sections of the community to
          have an equal chance to trade with us. The information requested below
          is voluntary and will not affect assessment of your application.
      5.13.
              How would you classify the overall majority ownership or
              control of your firm?


              Ethnic Origin –

                                                                                 Yes/No
              Black / Afro-Caribbean


              Black / Asian
                                                                                 Yes/No
              White / European
                                                                                 Yes/No
              Other (please specify)                                             Yes/No

     5.14     Workforce


              Do you monitor your workforce in terms of their age?               Yes/No


              Do you monitor your workforce in terms of their disability?        Yes/No


              Do you monitor your workforce in terms of their gender?            Yes/No


              Do you monitor your workforce in terms of their race?              Yes/No


              Do you monitor your workforce in terms of their religion or        Yes/No
              belief?


              If you have ticked “Yes” please provide evidence i.e.
              monitoring form, workforce statistics, targets, examples of
              positive recruitment adverts, etc




6.
            HEALTH AND SAFETY



            All firms should answer these questions.


            If your firm does not currently operate in the UK, you should still try to
       answer each question, substituting any law, code of practice etc, that is
       appropriate to your domestic jurisdiction.


6.1.
       Who is responsible for ensuring that your health and safety policy is
       implemented?


       Name:


       Position:


6.2.
       If your firm has five or more employees, please enclose a copy of
       your health and safety policy documentation (covering general           Enclosed
       policy) organisation and arrangements). This is required by
       section 2(3) of the Health and Safety at Work etc Act 1974.


6.3.
       If you have fewer than five employees, please enclose written
       details of:


       Your procedures in case of emergency


       Your procedures for reporting and recording accidents or
       dangerous occurrences


       Your first aid and welfare provisions
                                                                               Enclosed

       Your provision of appropriate protective clothing and equipment


6.4.
       Please attach details of how you communicate your health and
       safety policies and procedures to your employees and sub-               Enclosed
       contracted staff, and how they are administered within your firm.


6.5.
       During the last three years, has your firm been prosecuted for
       contravening the Health and Safety at Work etc. Act 1974 or other
       health and safety law, or has your firm been (or is currently) the
       subject of formal investigation by the Health and Safety Executive
       or similar national body which enforces health and safety               Yes/No
       standards?
            If Yes, please provide full details including preventative measures
            taken to ensure similar incidents do not occur in the future.




7.
            CONTRACT PERFORMANCE AND QUALITY MANAGEMENT


     7.1.
            Have any of the following circumstances occurred on any contract
            involving your firm during the last three years:


            A financial deduction or liquidated damages imposed                   Yes/No

            A contract terminated or your employment determined (terminated)      Yes/No

            A contract not renewed for failure to perform to the terms of the     Yes/No
            contract


            Withdrawal from a contract prematurely
                                                                                  Yes/No

            Outstanding claims or litigation against your company
                                                                                  Yes/No

            If yes please provide full details
8.
          BUSINESS STRUCTURE

     8.1. A brief description of the applicant's business structure is required. Applicants may wish
          to append a „family‟ tree to illustrate the structure.




     8.2. Which part of your organisation would deliver this service?




     8.3. Why do you think this will deliver a high quality service?




9.
          MANAGEMENT STRUCTURE

     9.1. A brief description of the applicant's management structure, relevant to the proposed
          activity, is required:




     9.2. Please give brief biographical details, including skills base and relevant experience of
          staff and/or managers to be employed in performing this contract awarded by the
          Council to the applicant:
10.
              RESOURCES

      10.1.
              Enter the number of persons employed (on the provision of services comparable to
              that proposed for this contract) during the last full year:



                                                                    Part Time          Full Time


               Managerial / Supervisory


               On site:
               Off site:



               Operational:




      10.2.
              Please indicate if it is proposed to sub-contract any part of the delivery of this service,
              with details of which part and how would it be managed and funded.



      10.3.
              Enter the number of full-time equivalent persons employed (on the provision of services
              comparable to that proposed) during each of the last three years:



                                                                 2008           2007           2006


               Managerial / Supervisory



               Operational




      10.4.   Please give details of care qualified staff currently employed by your organisation,
              specifying numbers of staff and professional qualifications.
10.5.   Please give details of specialist information technology and technical equipment used by
        your organisation in the delivery of services.
RESOURCES (CONTINUED)

        10.6.   Please give details of specialist services used by your organisation.



        10.7.   Which elements of the services detailed in the background information does your
                organisation anticipate may be sub-contracted?



        10.8.   Please provide a brief statement of how your company is committed to staff training
                and development. This will be explored in greater depth at a later stage in the
                selection process.




  11.
                STAFF TRAINING

        11.1.
                Please provide details of how training is implemented to all levels of management and
                staff involved in the management and delivery of the contract. Examples of this
                training in other contracts may be included.

        11.2.   Does your organisation have a training plan? If yes, please provide a copy.



        11.3.
                How does your company ensure that staff are competent?


        11.4.
                Give brief details of how your company communicates instructions to staff.
12.
              QUALITY ASSURANCE

      12.1.
              Evidence should be supplied of satisfactory processes and procedures to enable the
              Council to be assured that services can be delivered to the required frequency and
              quality. This evidence will form a key element in determining the suitability of the
              applicant to be awarded the contract.
              Please provide details of any quality assurance procedures and processes you have
              implemented that are relevant to this type of activity and any certificates obtained.

      12.2.
              How would you demonstrate successful contract delivery to the Council, if your
              company wins this contract?




              Policy



      12.3.
              What do you consider to be the critical performance indicator for this service?


      12.4.   Please state how your Lone Working policy would be relevant to, and implemented,
              in providing this service?



      12.5.   Please describe briefly your understanding of local and national policy priorities for
              informal / family carers?



      12.6.   Can you please confirm how your equal opportunities policy is embedded within
              your day to day operations?



              Procedure

      12.7.   How would you manage conflict resolution, and in what aspects of this service would
              you expect you may need to?
12.8.   Please state your organisations procedures for ensuring service user safety and
        how they would be relevant to this service?



12.9.   Please detail your proposed processes for overseeing and monitoring the service,
        and meeting the specification regarding reporting



12.10. What business continuity plans will you have in place if your procedures fail or
       cannot function due to unplanned and unforeseen difficulties? For example, failure
       of electronic system, very poor weather conditions, difficulty in accessing service
       delivery location, staff absence….



12.11. What are your processes for quality control within your organisation and how will
       they be applied to this contract?



12.12. How are your quality policies communicated throughout the organisation and
       tested to ensure effective implementation?



12.13. What procedures will you put in place to resolve a concern involving a performance
       issue that may arise under this contract?



12.14. How would you measure customer satisfaction with the service provided?



12.15. Please provide a draft job description for the main assessment / co-ordination post.



12.16. Provide the structure chart of the organisation as relevant to the delivery of this
       service



12.17. Please identify your process of employee consultation, communication and
       professional supervision within your organisation
       Provision
12.18. What training and development opportunities would you consider as relevant to this
       service, and how would you provide them?



12.19. Please detail the processes you would use to assess and manage risk within this
       contract. Please provide operational examples of how you will assess risk with
       regards to emergency support plans



12.20. Please provide examples of innovation, best practices, and responding to different
       communities and how you would propose to implement such practice in delivering
       this service.


12.21. How do you propose to ensure that emergency support plans are shared and
       available to all relevant staff at all relevant times – and what technology may be
       involved?



12.22. Please describe how you would mobilise resources to ensure delivery of the service
       across the whole of the Borough?



12.23. Please describe what specialist staff qualifications, skills or knowledge that you
       would consider important in delivering services to the client groups involved.



12.24. How will you plan to deal with changing volumes of demand for the service?



12.25. If successful, please provide an outline of how the service will be implemented from
       commencement through to the point of delivery. Please include timescales.
       Publicity
12.26. How would you envisage promoting this scheme?
13.
              LEGAL PROCEEDINGS


      13.1.
              Provide details of any court actions and / or industrial tribunals
              hearings in which this firm has been involved over the last three years.




      13.2.
              Provide details of any such court actions and/or industrial tribunal
              hearings that are currently outstanding




      13.3.
              Has the firm at any time:


              Being an individual been made bankrupt, had a receiving order or
              administration order made against them, made any composition or
              arrangement (whether formal or informal) with or for the benefit of their
              creditors or has made any conveyance or assignment for the benefit of
              their creditors or has had an interim receiver of their property
              appointed under Section 286 of the Insolvency Act 1986 or has been
              made the subject of an application for an interim order under Section
              253 of the Insolvency Act 1986.



              Being a partnership or cooperative, been involved in dissolution or
              termination


              Being a partnership:
                         o   Entered into a voluntary arrangement under clause 4 of
                             the Insolvent Partnership Order 1994 (“the Order”): or
                         o   Had a petition presented to any court for its winding up
                             under clauses 7 and 8 of the Order; or
                         o   Had a petition presented to any court for an
                             administration order clause 6 of the order:
                         o   Presented a petition for winding up under clauses 9
                             and 10 of the Order; or
                            o   Presented any joint bankruptcy petition under clause 11
                                of the Order.


                Being a company passed a resolution for winding up or been subject
                to an order of the Court for winding up otherwise than for the purposes
                                                                                           Yes/No
                of a bona fide reconstruction or amalgamation, or been the subject of
                any voluntary arrangement under Section 1 of the Insolvency Act 1986
                or had a receiver, manager administrator or administrative receiver on
                behalf of a creditor appointed in respect of the company‟s business or
                any part thereof


                Had a judgment debt of over £10,000 enforced against the company.


                If yes please, provide details:




LEGAL PROCEEDINGS (CONTINUED)


        13.4.
                Has the form or any proprietor, director, partner or associate thereof
                ever in the course of the business:


                Been convicted of a criminal offence relating to the conduct of that
                business, or
                                                                                          Yes/No

                Committed an act of grave misconduct in the course of that business



                If yes please provide details




  14.
                PARENT COMPANY AND GURANTEES


        14.1.                                                                             Yes/No
                Is the firm a subsidiary with an ultimate UK or overseas holding
                company
      14.2.
              If the firm is a member or group of companies, provide the following
              details for the Ultimate Holding Company and all subsidiaries


              Company Name:



              Address of Registered Office:



              Correspondence Address (if different):



              Telephone Number:



              Fax Number:



              Type of Organisation (public/private limited, partnership etc):



              Registered number:



      14.3.
              Would the ultimate holding company be prepared to guarantee your
              contract performance as its subsidiary?                                Yes/No

              If no, please provide details




15.
              FINANCIAL AND ECONOMIC INFORMATION


      15.1.
        Name of person with responsibility for financial matters



15.2.
        Name and address of bankers




15.3.
        Bank account number


15.4.
        Bank Sort Code number


15.5.
        Are we authorised to seek references from your bank?                    Yes/No


        If yes please provide a letter authorizing permission to seek           Enclosed
        references from the bank


15.6.
        Name and address of auditors



15.7. Provide a statement that the ownership of the firm has not changed        Yes/No
      significantly over the past 12 months.


        Where applicable please provide details                                 Enclosed




15.8.
        Provide a statement that the firm has not been subject to a financial
        investigation by an accredited UK or EU regulator.                      Enclosed

        Where applicable please provide details


15.9.
        In the last three years has the firm been subject to any outstanding    Yes/No
        legal or financial claims.
          If yes please detail any outstanding claims




FINANCIAL AND ECONOMIC INFORMATION (CONTINUED)


      15.10.
           Please provide the following details in relation to the guarantor of the firm


           Name:


           Name and Address of Bankers:



           Name and Address of Auditors:




           Statement of Accounts


           Turnover Information



                                                    Year            Year           Year


               Overall Turnover



               Domiciliary Care Services




      15.11.
           Provide a statement, as at the last reporting date, of any contingent liability or
           loss (where not otherwise reported) that would require disclosure in accordance
           with International Accounting Standard 10.
                 Provide a statement indicating the willingness to guarantee the firms
                 performance under the terms of the Council‟s contract.



                 Provide a statement that the ownership of the organisation has not changed
                 significantly over the past 12 months.


                 Where applicable please provide details



                 Provide a statement that the guarantor has not been subject to a financial
                 investigation by an accredited UK or EC regulator


                 Where applicable please provide details



                 Provide details of any outstanding legal or financial claims the guarantor is
                 subject to




16 – References
Please list below the full names, addresses and details of principal organisations for which your organisation has
provided similar services at any time during the last three years

If you wish the Authority to contact you before requesting a Reference please state below.

Please ensure that all nominated referees are notified and aware that a request by the Authority for a
reference, for inclusion as part of your Qualification application, is subject to receipt by the Authority by
____________________________ 2009

        Reference 1
        Name and Address of Organisation
        (Full postal address required)



        Name of person, position and telephone number

        Scope of Work


        Contract start and end date
Type of arrangement – e.g. joint venture



Contact you before we make contact?        YES   NO
        Reference 2
        Name and Address of Organisation
        (Full postal address required)



        Name of person, position and telephone number

        Scope of Work


        Contract start and end date

        Type of arrangement – e.g. joint venture



        Contact you before we make contact?                  YES                     NO




17 - DECLARATION

I certify that the information supplied is accurate to the best of my knowledge and that I accept the
conditions requested in the questionnaire. I understand that false information could result in exclusion
from consideration for the contract.




Name _______________________________________________
Signed _______________________________________________
Date ___________________________________________
For and on behalf of ___________________________________________________

				
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