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					                                             Technical Proposal




                                             Schedule 1

                                       Technical Proposal




Service Tender Reference: SWD1/5J/872/2010                        1
                                             Technical Proposal



                                       Technical Proposal

This Technical Proposal and where applicable, all information, proposals, plans, and
all other contents set out herein and all attachments hereto are given or offered by
*me/us for the Contract.


* delete where inapplicable.



Part A – Tenderer’s information

  Item                                             Information

A1         Name of the Tenderer:



A2         Business Entity and Registration Status of the Tenderer (a copy of the
           supporting document(s) where applicable should be submitted):

           (Put a  in the appropriate box(s) below and assign a number for each Annex sequentially)

           For NGO Only
            (a)       NGO incorporated under Companies Ordinance (Cap. 32)

                      Certificate of Incorporation under Companies Ordinance (Cap.
                       32) is attached in Annex __
                      Registration under section 88 of the Inland Revenue Ordinance
                       (Cap. 112) is attached in Annex __

            (b)       NGO incorporated by Statute

                      Relevant Ordinance is attached in Annex __
                      Registration under section 88 of the Inland Revenue Ordinance
                       (Cap. 112) is attached in Annex __

            (c)       NGO incorporated under the                     Registered       Trustees
                       Incorporation Ordinance (Cap. 306)

                      Relevant registration certificate is attached in Annex __
                      Registration under section 88 of the Inland Revenue Ordinance
                       (Cap. 112) is attached in Annex __

            (d)       NGO established under the Societies Ordinance (Cap. 151)

                      Relevant registration certificate is attached in Annex __
                      Registration under section 88 of the Inland Revenue Ordinance
                       (Cap. 112) is attached in Annex __



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           For Private Organisation Only
            (e)       Company Registered under Companies Ordinance (Cap. 32)

                      Certificate of Incorporation under Companies Ordinance (Cap.
                       32) is attached in Annex __

            (f)       Sole Proprietorship/Partnership

                      Business Registration Certificate is attached in Annex __

A3         Head office and place of business of the Tenderer with address:




A4         Name and address of each director, office bearer, member or partner of
           the Tenderer where the Tenderer is a company incorporated under
           Companies Ordinance Cap. 32, or a statutory corporation, or a
           corporation incorporated under the Registered Trustees Incorporation
           Ordinance Cap. 306, or a society registered under the Societies
           Ordinance Cap. 151, or a partnership (as the case may be):
           (insert more columns for completion if appropriate)
           Name and position:       Address:

           Name and position:                Address:

           Name and position:                Address:

A5         Name and address of each member or person with 10% or more
           beneficial ownership of shares or equity interest in the Tenderer if the
           Tenderer is a company or partnership:
           (insert more columns for completion if appropriate)

           Name:                                    Address:

           Ownership of shares                 or
           equity interest (%):

           Name:                                    Address:

           Ownership of shares                 or
           equity interest (%):

           Name:                                    Address:

           Ownership of shares                 or
           equity interest (%):




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A6         Name of authorised contact person of the Tenderer
            (a) Name:




            (b) Post:




            (c) Address:




            (d) Office Tel. Number:


            (e) Fax Number:


            (f) E-mail Address (if applicable):


A7         Where applicable, submission of detailed information of Sub-contractor(s)
           and/or agent(s) to be engaged by the Tenderer for the part of Services to
           be provided in accordance with Section B1.2.1 of this Technical Proposal,
           and letters from these Sub-contractors and/or persons showing their
           commitment to provide such part of Services on the terms and conditions
           specified in such documents, and information on the type and scope of
           Services to be provided by these Sub-contractors and/or agents.

                                 Not applicable
                                 Document is attached in Annex _____

           (Put a  in the appropriate box and assign an Annex number sequentially)




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A8         Submission of a copy of the valid licence of a residential care home for
           the elderly, nursing home, or hospital (as the case may be) as proof that
           the Tenderer is currently operating a residential care home for the elderly,
           nursing home, or hospital in Hong Kong. If the organisation which
           operates the said residential care home for the elderly, nursing home or
           hospital is not the same as the Tenderer, the Tenderer shall indicate
           clearly in the space below whether one of the directors, office bearers,
           trustees, members or partners of the Tenderer is in fact that organisation,
           or is a director of that organisation. If the latter case is applicable,
           name(s) of director(s) of the residential care home for the elderly, nursing
           home or hospital (with documentary proof) shall be submitted as proof that
           one of the directors, office bearers, trustees, members or partners of the
           Tenderer is also a director of that organisation.




                          Document is attached in Annex _____

           (Assign an Annex number sequentially)


A9         Information of the residential care home for the elderly, nursing home, or
           hospital in Hong Kong stated in Item A8 above for the Government to
           conduct an unannounced site visit during the selection period:

            (a) Name of Home:


            (b) Address of Home:


            (c) Contact Person:


            (d) Telephone Number:




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A10        Complete this part only if the Home stated in Item A9 above is a
           residential care home for the elderly cum nursing home
           If the Home stated in Item A9 above is a residential care home for the
           elderly cum nursing home, please indicate in the appropriate box below
           the section of the Home which will be available for the Government to
           conduct the unannounced site visit. A copy of the valid licence of the
           section/part ticked below shall be submitted if it is different from the
           licence submitted under Section A8.
           (Select only one section below for assessment purpose)

                                 residential care home for the elderly, OR

                                 nursing home

                                 Document is attached in Annex _____ (if applicable)


           (Put a  in the appropriate box, and if applicable, assign an Annex number sequentially)




                                             - End of Part A -




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Part B - Service Plan

Section B1 - Mode of Delivery

B1.1         Care Setting

B1.1.1   Safe and Supportive Environment
B1.1.1.1 Measures to adapt the physical environment to meet the special care
         needs of Service Users with physical and cognitive impairment, e.g.
         lighting, wandering area/path, etc.:




B1.1.1.2 Use of materials and colour scheme such as colour contrast in
         decoration to reduce potential risks to Service Users:




B1.1.1.3 Measures for taking overall safety into consideration, e.g. layout design
         or devices to prevent confused Service Users from walking away or
         injuring themselves, etc.:




B1.1.2   Home-like and Comfortable Environment
B1.1.2.1 Provision of user-friendly living environment for all Service Users, e.g.
         warm colour scheme, display of pictures and photos, decorations in
         common areas/corridors/dormitories, etc.:




B1.1.2.2 Enhancement of social interactions among Service Users and provision
         of privacy for Service Users, e.g. arrangement of seats, semi-private
         and private spaces, etc.:




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B1.1.2.3 Promotion of individuality, e.g. personalise the space occupied by the
         Service Users, etc.:




B1.1.3   Fitting-out Works-related Submission
B1.1.3.1 Fitting-out Works-related Submission is attached in Annex _____
         (The Submission should be in conformity with paragraphs 1.2,
         2.2.1, 2.2.2, and 2.2.5 of the Floor Plans and Technical
         Requirements for Fitting-out Works.)



             (Assign an Annex number sequentially)

B1.1.3.2 Due consideration taken to demonstrate proper zoning and functional
         relationship between various room types, and the corridors/routes
         inter-linking these rooms are efficient and would streamline daily
         operational activities:




B1.1.3.3 Innovative use of space to bring about spatial gains/merits:




B1.1.3.4 Good practices/designs/installations relating to energy saving, indoor air
         quality, or other building services aspects:




B1.1.3.5 Environmental responsive design, e.g. noise mitigation measures,
         maximisation of view, cross ventilation and natural lighting to rooms,
         etc.:




B1.2         Clinical Intervention, Personal Care and Other Services
B1.2.1       Staff Mix for the Delivery of the Services


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                                                                  Number of staff                 Type of service
                                 Type of                             (full-time                  (number of hours
                            professional/care                    equivalent)2 to be               per week) to be
                             staff/services1                         employed                       purchased
                      Director of
                                                                                                           N/A
                      Administration3
                      Registered Nurse (RN)
                      (including one RN taking up                                                          N/A
                      the post of Director of Care)
                      Enrolled Nurse (EN)                                                                  N/A
                      Care Worker                                                                          N/A
                      Social Worker                                                                        N/A
                      Physiotherapist
                      Occupational Therapist
                      Medical Practitioner
                      Dietician
                      Dispenser
                      Ancillary staff (such as
                      clerk, cook, driver,
                      workman, etc.)
                      Others (please specify)
                                                                                                   (frequency of
                      Dental Check-up                                                            service per year)
                                                                           N/A
                      Service

                 Condition 1:           The Operator shall comply with the minimum staffing
                                        requirements specified in paragraph 3.1.11 of the
                                        Service Specifications for the discharge of the Services.
                 Condition 2:           The Operator shall also maintain a staffing level not less
                                        than the commitment stated in the above table.
                 Condition 3:           The Operator shall directly employ the committed
                                        number of Director of Administration, Registered Nurses,
                                        Enrolled Nurses, Care Workers and Social Worker on
                                        full-time or equivalent basis.        No sub-contractual
                                        arrangement shall be made in the discharge of these
                                        services by these personnel.
B1.2.2           Qualification/Training of Staff for the Discharge of the Services



1
    The provision of staff/services other than those mentioned in Condition 3 of Section B1.2.1 of this Technical Proposal may be
    through either direct employment OR purchased from outside bodies.
2
    Full-time equivalent is taken to be 44 working hours per week. For example, if it involves two part-time staff each working 30
    hours per week, the number of full-time equivalent staff in this case will be (30+30)÷44.
3
    The Director of Administration is responsible for the overall administration and management of the Services and shall be
    counted as a single post from the rest of the staffing provision regardless of the professional background of the post holder.



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B1.2.2.1 Staff with the following types of qualification/training upon employment:


                                      Qualification obtained/Training received upon
                                                       employment
                    Rank           Gerontology/ Dementia First Aid Infection Others (please
                                   Geriatric Care Care              Control     specify)

                  Director of
                Administration
               Director of Care
                     (RN)
                  Registered
                 Nurse (RN)
               Enrolled Nurse
                     (EN)
                 Care Worker
                Others (please
                   specify)




B1.2.2.2 Percentage of care workers that have completed Personal Care Worker
         training course upon employment:




B1.2.2.3 Duty roster for registered nurses for the fulfilment of the requirements
         set out in paragraphs 3.1.11(b) and (c) in the Service Specifications:



                                                                     Minimum Number of
                       Daily Working Hours
                                                                  Registered Nurses on Duty

                    From ______ to ______

                    From ______ to ______

                    From ______ to ______




B1.2.3       Addressing Various Clinical Issues



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B1.2.3.1 Information and all available procedures relating to the management of
         the clinical issues and the delivery of services to address various
         clinical issues pertaining to the needs of individual Service Users as set
         out in paragraph 2.6.2 of the Service Specifications:


                              Procedures on Clinical Issue           Attached in

               (a)      prevention and management of falls           Annex _____
               (b)      maintenance of skin integrity                Annex _____
               (c)      management of wounds                         Annex _____
               (d)      prevention and management of pressure sores Annex _____
                        prevention and management of urinary and
               (e)                                                   Annex _____
                        faecal incontinence
               (f)      prevention and management of constipation    Annex _____
                        supervision of medications including use of
                        psychotropic medication, administration of
               (g)                                                   Annex _____
                        injectable medication and selective
                        intravenous therapy
                        nutritional and dietary management including
               (h)                                                   Annex _____
                        special diet and tube feeding
               (i)      management of chronic pain                   Annex _____
                        management of special nursing procedure:
               (j)                                                   Annex _____
                        e.g. tracheotomy care, oxygen therapy
               (k)      management of depression                     Annex _____
               (l)      maintenance and restorative rehabilitation   Annex _____
                        prevention and management of cognitive
               (m)                                                   Annex _____
                        impairment
                        prevention and management of agitated and
               (n)                                                   Annex _____
                        aggressive behaviour
              (Assign an Annex number sequentially)


B1.2.3.2 Approaches adopted in the development of Clinical Practice Guidelines
         especially in relation to (i) evidence based and, (ii) multi-disciplinary
         collaboration:




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B1.2.3.3 Approaches adopted in the review of whole set of Clinical Practice
         Guidelines, including and without limitation to multi-disciplinary
         collaboration, and frequency of review:




B1.2.3.4 A sample Individual Care Plan of one mock case completed with
         information on (a) Service User’s assessed conditions and needs, (b)
         risk assessment, (c) services required, (d) timeframe for review, and (e)
         involvement of Service User and/or family member in the formulation
         and review of Individual Care Plan is attached in Annex _____.
         Supplementary information/explanation, if any, is as follows:




             (Assign an Annex number sequentially)


B1.2.3.5 Mechanism (i) to facilitate effective implementation of Individual Care
         Plans for each Service User; and (ii) to monitor the compliance of
         Individual Care Plans by care staff:




B1.2.3.6 Procedures for the review of Individual Care Plans in response to
         changes of Service Users’ conditions or occurrence of clinical incidents:




B1.2.4   Addressing Psycho-social Needs of Service Users
B1.2.4.1 A concrete and feasible plan for the delivery of services to address
         various psycho-social needs of Service Users required under paragraph
         2.6.7(d) and (e) of the Service Specifications, how and what services to
         be organised and provided to address these needs and the timeframe:




B1.2.4.2 Means to promote Service Users’ participation in activities in the
         community:




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B1.2.4.3 Means to facilitate family involvement and community participation in
         Service Users’ activities:




B1.2.5   Implementing Least Restraint Policy
B1.2.5.1 Workable and practicable measures to implement a least restraint
         policy, including the use of alternatives to restraints:




B1.2.5.2 Provision of education programmes for staff, Service Users and their
         family members on the principles and practices of the least restraint
         policy:




B1.2.5.3 Mechanism to monitor the compliance of the least restraint policy by
         staff:




B1.2.5.4 Mechanism to evaluate the effectiveness of the least restraint policy on
         a regular basis:




B1.3         Management Support
B1.3.1       Proposed Plan to Promote Holistic Care
             Concrete and feasible plan for the provision of support services for
             family members of Service Users:




B1.3.2   Implementing Infection Control Programme
B1.3.2.1 Measures to facilitate infection control practices through the design and
         use of the physical setting, e.g. separate routes/exits for handling clean
         supplies and waste, etc.:




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B1.3.2.2 Provision of additional equipment other than the items specified in the
         Furniture and Equipment (F&E) Reference List mentioned in paragraph
         5(e) of the Guidelines on Submission of Proposals for enhancing
         infection control measures:




B1.3.2.3 Mechanism to monitor the implementation of infection control including
         development of infection control protocols and designation of personnel
         responsible for the co-ordination of infection control monitoring and
         improvement activities:



B1.3.2.4 Concrete plan for training and educational activities for staff, Service
         Users and their family members on infection control in the home:




B1.3.3   Risk Management System
B1.3.3.1 Mechanism for handling emergency situations in case of (a)
         injuries/accidents, (b) violence, and (c) medical emergencies:




B1.3.3.2 Contingency planning for (i) service breakdown, and, (ii) for
         management of emergency situation of Premises in case of (a) fire, and
         (b) interruption of utilities supply/facilities for a prolonged period:



B1.3.4   Handling of Complaints and Feedback
B1.3.4.1 Guidelines and procedures to ensure that all complaints are duly
         handled by appropriate staff:




B1.3.4.2 Other than the Service Users Council and Family Council,
         mechanisms/means to collect feedback from Service Users and their
         family members on a regular basis to facilitate continuous service
         improvement:




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B1.3.4.3 Mechanism to ensure that appropriate follow-up actions are taken by
         staff to respond to Service Users’ and their family members’ feedback:




B1.3.4.4 Designated staff to oversee and review the effectiveness of the
         complaint handling procedures and feedback mechanism:




B1.3.5   Financial Management System
B1.3.5.1 Budget planning and cash flow projections, and mechanism to identify
         and respond to budget variance:




B1.3.5.2 Policy and procedures to ensure segregation of duties, proper
         delegation and authorisation, e.g. delegation of authority for signing
         documents and payments at different amounts and procurement of
         goods and services, etc.:




B1.3.5.3 Measures of assets management, e.g. designated staff to handle and
         record inventory, regular stock-taking arrangement, etc.:




B1.3.5.4 Guidelines and procedures in handling Service Users’ properties, in
         particular their belongings and pocket money kept in the home:




B1.3.5.5 Any other measures that contribute to a sound financial management
         system (e.g. an internal audit system):




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B1.4     Human Resource Management
B1.4.1   Remuneration Packages
B1.4.1.1 Remuneration packages (including wages and working hours) for care
         workers and non-skilled workers to attract staff with the commitment
         and experience required to deliver the Services according to the
         Service Specifications:


                               Type of Staff                       Lowest Hourly Wage (HK$)

                Care Workers
                Non-skilled Workers (e.g. workmen)

                                                                  Number of Working Hours for
                               Type of Staff                           the Longest Shift
                                                                    (excluding meal break)
                Care Workers
                Non-skilled Workers (e.g. workmen)


B1.4.1.2 Procedures for staff recruitment:




B1.4.1.3 Procedures for staff promotion:




B1.4.1.4 Mechanism to assess the capability and performance of staff, e.g.
         regular supervision, appraisals, monitoring of performance, etc.:




B1.4.1.5 Provision of staff development and in-service training:




B1.4.1.6 Retention strategies other than “promotion” for nurses and care
         workers:




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B1.5         Value-added Services
B1.5.1a      Provision of special devices and furniture and equipment (F&E) to
             support the care of Service Users with physical and cognitive
             impairments other than the items specified in Furniture and Equipment
             Reference List contained in paragraph 5(e) of the Guidelines on
             Submission of Proposals; and/or

             provision of F&E in excess of the quantity of the prescribed items
             specified in the Furniture and Equipment Reference List:



B1.5.1b      Concrete and feasible plan for the provision of other value-added
             services provided for Service Users free of charge or at cost, e.g. free
             minor repair and maintenance services for Service Users’ rehabilitative
             equipment, etc.:




Section B2 – Non-subsidised Residential Care Places
B2.1     Number of Provision
             (The number for Non-subsidised Residential Care Places must be
             provided within the range specified in paragraph 1.3 of Terms of
             Tender, otherwise no score will be awarded.)
                   Number of Non-subsidised Residential
                   Care Places to be provided




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B2.2             Fee-charging (The room capacity and the number of rooms stated
                 below shall be in line with the layout stated in the Fitting-out
                 Works-related Submission and the total provision of
                 Non-subsidised Residential Care Places shall be in line with the
                 number stated in B2.1 above.) In the event of inconsistency, no
                 score will be awarded.

                      Level of Impairment                       Room Capacity (Number of Rooms)
                                                         (May propose different room capacities e.g. 1-person room,
                    (Moderate/severe according to                  2-person room, 4-person room, etc.)
                     the Standardised Care Need    Room Capacity
                      Assessment Mechanism for
                           Elderly Services)      Number of Rooms


                              Moderate                 HK$ per Month
                                                             per
                                                       Non-subsidised
                                                       Residential Care
                                Severe                      Place

                 Condition 1:        The monthly fee quoted for the Non-subsidised Residential
                                     Care Places, inclusive of the air-conditioning charge, shall be
                                     valid and remain unchanged throughout the Term, unless prior
                                     approval in writing has been obtained from the Department.
                                     The Operator is free to charge less than the monthly fee
                                     quoted.    If the Operator wants to apply for an upward
                                     adjustment of the monthly fee, the adjustment should normally
                                     be in line with the increase in the Composite Consumer Price
                                     Index over a period to be approved by the Government in
                                     accordance with paragraph 2.4.2 of the Service Specifications.

                 Condition 2:        The Operator must provide Non-subsidised Residential Care
                                     Places within the range specified in paragraph 1.3 of Terms of
                                     Tender. The number of rooms and room capacities proposed
                                     shall be valid and remain unchanged throughout the Term,
                                     unless prior approval in writing has been obtained from the
                                     Department. Where necessary, application for change in
                                     number of rooms or room capacities should include proposed
                                     amendments to fees to be charged for different room capacities
                                     and/or impairments so that the resultant average fee4 will not
                                     exceed the average fee calculated based on the fee-charging
                                     proposal set out in the above table or the increased monthly fee
                                     applied under Condition 1 above, as the case may be. The
                                     Operator shall seek approval in writing from the Department
                                     prior to implementing the new fee charges.




4
    Average fee quoted is calculated based on the weighted average of the fees to be charged for different room capacities and/or
    impairment levels in the manner mentioned in footnote (1) inserted in paragraph (d) under the heading “Part B: Quality
    Assessment” in the Terms of Tender.



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Section B3 - Respite Places

                                                         Daily fee chargeable per Service
  Service
                                                         User
  Residential Respite Care utilising
  Non-subsidised Residential Care Places                           HK$ _________



                                             - End of Part B -




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Part C – Offer to be Bound


Having read and understood all terms and conditions of the Tender Documents, *I/we
hereby warrant that all information given in or attached to this Technical Proposal are
true, complete and correct.

*I/We, as the Tenderer, agree to all terms and conditions set out in the Tender
Documents.

*I/We HEREBY OFFER to provide the Services on and subject to the terms and
conditions set out in the Contract and the Technical and Volume Proposals contained
in *my/our tender for the Contract.



Signed by the Tenderer or by the
authorised signatory for and on behalf of
the Tenderer:

Name of the authorised signatory
(in Block Letters):

Post/Title of the authorised signatory
(in Block Letters):

Hong Kong Identity Card Number of the
authorised signatory:


Name of the Tenderer (in Block Letters):


Signature of the witness:


Name of the witness (in Block Letters):

Hong Kong Identity Card
Number of the witness:


Dated:


* delete where inapplicable




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In the case the Tenderer is a group of office-bearers of a society registered or
exempted from registration under the Societies Ordinance:



 Signed by an office-bearer of the society :
 Name and title/post of the office-bearer
 (in Block Letters):
 Name of the society in English
 (in Block Letters):
 Name of the society in Chinese
 (in Block Letters):


 Tel No. :                           Fax No. :                    Date :


 Signed by an office-bearer of the society :
 Name and title/post of the office-bearer
 (in Block Letters):
 Name of the society in English
 (in Block Letters):
 Name of the society in Chinese
 (in Block Letters):


 Tel No. :                           Fax No. :                    Date :


[NB: Please use the above execution clause for multiple office-bearers. At least two
office-bearers of the society must sign.]




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                                             Technical Proposal



Part D (1) – Letter of Consent and Authorisation

[This form should be completed by the Tenderer regardless of its business
entity and/or registration status (including company and partnership)]

*I/We hereby give consent to the Social Welfare Department to obtain from all
relevant government departments/other public bodies and the residential care home
for the elderly, nursing home or hospital as specified in Part A Items A9 and A10 of
this Technical Proposal, and *I/we hereby authorise all such relevant government
departments/other public bodies and the residential care home for the elderly, nursing
home, or hospital as specified in Part A Items A9 and A10 of this Technical Proposal
to release and make available to the Social Welfare Department, all documents and
information in connection with:

1.      all *my/our past conviction records for offences under the Residential Care
        Homes (Elderly Persons) Ordinance (Cap. 459), the Hospitals, Nursing Homes
        and Maternity Homes Registration Ordinance (Cap. 165), the Immigration
        Ordinance (Cap. 115) and the Employment Ordinance (Cap. 57) relating to
        *me/us.

2.      track record, current documents and files of the residential care home for the
        elderly, nursing home, or hospital in Hong Kong currently operated by *me/us
        as particularised in Part A Items A9 and A10 of Technical Proposal to which
        this consent is attached.


Signed by the Tenderer or by the authorised
signatory for and on behalf of the Tenderer:

Name of the authorised signatory (in Block Letters):

Post/Title of the authorised signatory
(in Block Letters):

Hong Kong Identity Card Number of the authorised
signatory:

Name of the Tenderer (in Block Letters):


Signature of the witness:

Name of the witness (in Block Letters):

Hong Kong Identity Card Number of the witness:

Dated:

* delete where inapplicable




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                                             Technical Proposal



Part D (2) – Letter of Consent and Authorisation

[Where the Tenderer is a company or partnership, this form should be
completed by each member or person with 10% or more beneficial ownership
of shares or equity interest in the company or partnership and should be
attached to the Technical Proposal submitted by the Tenderer]


*I/We hereby give consent to the Social Welfare Department to obtain from all
relevant government departments/other public bodies and the residential care home
for the elderly, nursing home, or hospital as specified in Part A Items A9 and A10 of
this Technical Proposal, and *I/we hereby authorise all such relevant government
departments/other public bodies and the residential care home for the elderly, nursing
home, or hospital as specified in Part A Items A9 and A10 of this Technical Proposal
to release and make available to the Social Welfare Department, all documents and
information in connection with all *my/our past conviction records for offences under
the Residential Care Homes (Elderly Persons) Ordinance (Cap. 459), the Hospitals,
Nursing Homes and Maternity Homes Registration Ordinance (Cap. 165), the
Immigration Ordinance (Cap. 115) and the Employment Ordinance (Cap. 57) relating
to *me/us.




Signature of *member/shareholder of the
Tenderer:

Name of *member/shareholder of the Tenderer
(in Block Letters):

Hong Kong Identity Card Number of
*member/shareholder of the Tenderer
(if applicable):

Name of the Tenderer (in Block Letters):


Signature of the witness:

Name of the witness (in Block Letters):

Hong Kong Identity Card Number of the witness:

Dated:


* delete where inapplicable




Service Tender Reference: SWD1/5J/872/2010                                         23

				
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Jun Wang Jun Wang Dr
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