ANNEX C
STANDARD SUBMISSION FORM
Second European Union Minorities and Discrimination Survey (EU-MIDIS II)
D-SE-14-T07	
SUBMITTED BY:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
1. PREAMBLE
Tenderers are requested to include in their tenders all the information and documents requested in the forms attached, in accordance with Annex A – Tender Specifications and the instructions below:
All forms must be dated, signed and stamped by a person authorised to sign on behalf of the tenderer. 
In case of a consortium or group of companies, the tender must be signed by the person appointed in the power of attorney (Form A.4) as authorised to sign the tender on behalf of the consortium or group of companies. 
Each consortium partner must sign a Declaration of Honour with respect to the Exclusion Criteria and Absence of Conflict of Interest (Form B.1). For each identified subcontractor whose intended share of the contract is above 10% of the total contract amount, a signed Declaration of Honour must also be provided.
Each identified subcontractor must complete and sign the Letter of Intent included in Form A.6. 
If the tenderer relies on the economic, financial, technical and professional capacity of the proposed subcontractor(s) to meet the selection criteria, then the subcontractors shall also complete the forms included under Sections C and D. In any other case, the forms included under Sections C and D shall only be completed by the tenderer or by the partners in case of consortium or group of companies. 
Tenderers’ financial offer shall be prepared in accordance with Form F.1 and shall be submitted in a separate sealed envelope clearly stating “Financial Offer”.
2. CHOICE OF LOT(S) 
Not applicable.
SECTION A – TENDERERS IDENTIFICATION

FORM A.1 – ADMINISTRATIVE DETAILS	
1. TENDERER’S DETAILS	
Company or organisations’ name		
Legal form 		
Date of registration		
Country of registration		
Registration number		
VAT number		
Address of registered office 		
Contact address (if different)		
URL		
			
2. TENDERERS’ REPRESENTATIVE(S) 	
Person authorised to sign the contract on behalf of the tenderer:	
Name		
Forename		
Position 		
Telephone 		
Fax 		
Email 		
Contact person regarding this tender:	
Name		
Forename		
Position 		
Telephone 		
Fax 		
Email 		
Signed (authorised signature) on behalf of the Tenderer
Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

FORM A.2 – LEGAL ENTITIES FORM
A standard template in each EU language is available at:
http://ec.europa.eu/budget/execution/legal_entities_en.htm 
Please choose the appropriate form (legal entity form for either individuals, private companies or public entities) and attach the necessary supporting documents as required (see instructions in the file). 

FORM A.3 – BANK IDENTIFICATION FORM
A standard template in each EU language is available at:
http://ec.europa.eu/budget/execution/ftiers_en.htm

FORM A.4 – POWER OF ATTORNEY
(DESIGNATING ONE OF THE COMPANIES OF THE GROUP AS LEADER AND GIVING A MANDATE TO IT)
We, the undersigned:
– Signatory 1 (Name, Function, Company, Registered address, VAT Number)
– Signatory 2 (Name, Function, Company, Registered address, VAT Number)
– …..
– Signatory N (Name, Function, Company, Registered address, VAT Number),
Each of them having the legal capacity required to act on behalf of his/her company,
HEREBY AGREE AS FOLLOWS:
1.	In case the European Union Agency for Fundamental Rights awards the Contract D-SE-14-T07 (the Contract) to Company 1, Company 2, …, Company N (the Group Members), based on the joint offer submitted by them on [to be completed] for the provision of services related to the Second European Union Minorities and Discrimination Survey (EU-MIDIS II) the Services, all the partners, as co-signatories of the Contract:
a.	Shall be jointly and severally liable towards the European Union Agency for Fundamental Rights for the performance of the Contract.
b.	Shall comply with the terms and conditions of the Contract and ensure the proper execution of their respective share of the services.
2.	To this effect, the Group Members designate Company [to be completed] as Group Leader. 
3.	Payments by the European Union Agency for Fundamental Rights related to the Supplies or the Services shall be made through the Group Leader’s bank account.
4.	The Group Members grant to the Group Leader all the necessary powers to act on their behalf in connection with the services. This mandate involves in particular the following tasks :
a.	The Group Leader shall sign any contractual documents — including the Contract — and issue any invoices related to the services on behalf of the Group Members.
b.	The Group Leader shall act as single point of contact for the European Union Agency for Fundamental Rights in connection with the services to be provided under the Contract. It shall co-ordinate the provision of the services by the Group Members to the European Union Agency for Fundamental Rights, and shall see to a proper administration of the Contract.
Any modification to the present agreement / power of attorney shall be subject to approval from the European Union Agency for Fundamental Rights.
This agreement / power of attorney shall expire when all the contractual obligations of the Group Members towards the European Union Agency for Fundamental Rights in connection with the services to be provided under the Contract have ceased to exist. The parties cannot terminate it before that date without the consent of the European Union Agency for Fundamental Rights.

Signed in	…………………… on ……….. ……..
Name		……………………………………………
Function	……………………………………………
Company	……………………………………………

FORM A.5 – STATEMENT ON SUBCONTRACTING
Please indicate (by ticking the appropriate box) whether the tenderer intends to subcontract all or part of the performance of the Contract, if awarded. 
□	YES, the tenderer intends to subcontract all or part of the performance of the Contract, if awarded.
□	NO, the tenderer does not intend to subcontract all or part of the performance of the Contract, if awarded.
If YES, please specify which parts of the Contract, and the name and address of any subcontractor(s).
Description	Percentage of the contract	Subcontractor	
	%	Name:
Address:	
	%	Name:
Address:	
	%	Name:
Address:	
	%	Name:
Address:	
Signed (authorised signature) on behalf of the Tenderer
Full name:	………………………………………
Date:		………………………………………
Signature:	……………………………………...	Stamp:	………………………………………..

FORM A.6 – LETTER OF INTENT FOR SUBCONTRACTORS
The undersigned: 
[complete]
Name of the company/organisation: 
[complete]
Address: 
[complete]
Tender reference:
D-SE-14-T07
Declares hereby that, in case the contract is awarded to [name of the tenderer], the company/organisation that he/she represents, intends to collaborate in the execution of the tasks subject to this call for tender, in accordance with the technical specifications and the tender to which the present form is annexed, and is available to carry out its part of the tasks during the period foreseen for the execution of the contract.  
Declares hereby accepting the General Conditions of the Draft Contract attached to the invitation to tender for the above call for tenders, and in particular, those provisions referring to subcontracting and check and audits.

Place and date:	……………………………………………

Name and signature:	……………………………………………
SECTION B – EXCLUSION CRITERIA

FORM B.1 - DECLARATION OF HONOUR WITH RESPECT TO THE EXCLUSION CRITERIA AND ABSENCE OF CONFLICT OF INTEREST
The undersigned (insert name of the signatory of this form):
•	in [his][her] own name (for a natural person)
or
•	representing the following legal person: (only if the economic operator is a legal person)
full official name:
official legal form:
full official address:
VAT registration number:
•	declares that [the above-mentioned legal person][he][she] is not in one of the following situations:
a)	is bankrupt or being wound up, is having its affairs administered by the courts, has entered into an arrangement with creditors, has suspended business activities, is the subject of proceedings concerning those matters, or is in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
b)	has been convicted of an offence concerning professional conduct by a judgment of a competent authority of a Member State which has the force of res judicata;
c)	has been guilty of grave professional misconduct proven by any means which the contracting authorities can justify including by decisions of the European Investment Bank and international organisations;
d)	is not in compliance with all its obligations relating to the payment of social security contributions and the payment of taxes in accordance with the legal provisions of the country in which it is established, with those of the country of the contracting authority and those of the country where the contract is to be performed;
e)	has been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation, money laundering or any other illegal activity, where such activity is detrimental to the Union's financial interests;
f)	is subject to an administrative penalty for being guilty of misrepresenting the information required by the contracting authority as a condition of participation in a grant award procedure or another procurement procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts or grants covered by the Union's budget.
•	(Only for legal persons other than Member States and local authorities, otherwise delete) declares that the natural persons with power of representation, decision-making or control over the above-mentioned legal entity are not in the situations referred to in b) and e) above; 
•	declares that [the above-mentioned legal person][he][she]:
g)	has no conflict of interest in connection with the contract; a conflict of interest could arise in particular as a result of economic interests, political or national affinity, family, emotional life or any other shared interest;
h)	will inform the contracting authority, without delay, of any situation considered a conflict of interest or which could give rise to a conflict of interest;
i)	has not granted and will not grant, has not sought and will not seek, has not attempted and will not attempt to obtain, and has not accepted and will not accept any advantage, financial or in kind, to or from any party whatsoever, where such advantage constitutes an illegal practice or involves corruption, either directly or indirectly, inasmuch as it is an incentive or reward relating to award of the contract;
j)	provided accurate, sincere and complete information to the contracting authority within the context of this procurement procedure ;
•	acknowledges that [the above-mentioned legal person][he][she] may be subject to administrative and financial penalties if any of the declarations or information provided prove to be false. 
In case of award of contract, the following evidence shall be provided upon request and within the time limit set by the contracting authority:

For situations described in (a), (b) and (e), production of a recent extract from the judicial record is required or, failing that, a recent equivalent document issued by a judicial or administrative authority in the country of origin or provenance showing that those requirements are satisfied. Where the tenderer is a legal person and the national legislation of the country in which the tenderer is established does not allow the provision of such documents for legal persons, the documents should be provided for natural persons, such as the company directors or any person with powers of representation, decision making or control in relation to the tenderer.
For the situation described in point (d) above, recent certificates or letters issued by the competent authorities of the State concerned are required. These documents must provide evidence covering all taxes and social security contributions for which the tenderer is liable, including for example, VAT, income tax (natural persons only), company tax (legal persons only) and social security contributions.
For any of the situations (a), (b), (d) or (e), where any document described in two paragraphs above is not issued in the country concerned, it may be replaced by a sworn or, failing that, a solemn statement made by the interested party before a judicial or administrative authority, a notary or a qualified professional body in his country of origin or provenance.
If the tenderer is a legal person, information on the natural persons with power of representation, decision making or control over the legal person shall be provided only upon request by the contracting authority. 

Full name:……………………………..  Date:……………………………

Signature:……………………………..  Stamp:…………………………
SECTION C – SELECTION CRITERIA (ECONOMIC AND FINANCIAL CAPACITY)

FORM C.1 – COPY OF BALANCE SHEETS AND PROFIT AND LOSS ACCOUNTS
Please attach copy of balance sheets and profit and loss accounts in accordance with the instructions provided in Annex A – Tender Specifications.

FORM C.2 – STATEMENT OF ANNUAL TURNOVER
Please fill in the table below in accordance with the instructions provided in Annex A – Tender Specifications: 
Statement on annual overall turnover (in EURO)	
Tenderer’s name	Current year -2	Current year -1	
Partner 1			
Partner 2			
Etc…			
Total			
(please add rows and columns if needed).] 

Signed (authorised signature) on behalf of the Tenderer
Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

SECTION D – SELECTION CRITERIA (TECHNICAL AND PROFESSIONAL CAPACITY)

FORM D.1 – EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS
Please provide the CVs in Europass format of the person or persons responsible for performing the contract, in particular of those profiles requested in the Tender and Technical Specifications. 
The CV template and the respective instructions can be downloaded under the following link: http://europass.cedefop.europa.eu/europass/home/hornav/Downloads.csp

Note: In the selection grid, the person(s) proposed for each profile must confirm that they fulfil the listed minimum criteria by ticking off “yes” or “no”. Furthermore, it is expected that under “specify” the relevant experience is listed and described in order to show how the minimum criteria as described in Section 8 of Annex A.1 – Technical Specifications are met. Please do not refer to the CV. The selection grid must be duly signed and dated by the person proposed for the profile.

SELECTION GRID – Project Coordinator
Last Name (in capitals): 
First name: 
Gender: 	Male: 
		Female: 
 (1)	University degree followed by	Yes 	No 	
	Specify:	
		
 (2)	A minimum of seven (7) years of professional experience, out of which a minimum of three (3) years’ experience of having conducted major international social science-based comparative research surveys in the European Union	Yes 	No 	
	Specify:	
		
 (3)	Proven experience in research management, as manager or coordinator of at least two (2) international survey projects, each project involving at least three countries	Yes 	No 	
	Specify:	
		
 (4)	Excellent knowledge of English (Level C1 based on Common European Framework of Reference (CEF))	Yes 	No 	
	Specify:	
		
*Note: Overlapping periods of professional experience will be counted only once; where additional periods of training and studies are accompanied by period of professional activity, only the latter shall be considered as professional experience; professional activities pursued part-time shall be calculated pro-rata, on the basis of the certified percentage of full-time hours worked
Declaration of honour (* Mandatory fields) 

I declare that the information provided above is, to my knowledge, true and complete.

Date/Signature

SELECTION GRID – Senior Survey Expert
Last Name (in capitals): 
First name: 
Gender: 	Male: 
		Female: 
 (1)	University degree followed by	Yes 	No 	
	Specify:	
		
 (2)	A minimum of seven (7) years of professional experience, out of which a minimum of three (3) years’ experience of having conducted international social science-based surveys on minority groups or hard to reach populations.	Yes 	No 	
	Specify:	
		
 (3)	At least three (3) scientific publications (e.g. articles in peer reviewed academic journals or books, or peer reviewed book chapters, or books by academic publishers) on issues related to any of the survey topics, e.g., surveying ethnic minorities and immigrant populations or discrimination and victimisation surveys or migration and integration issues. 	Yes 	No 	
	Specify:	
		
 (4)	Excellent knowledge of English (Level C1 based on Common European Framework of Reference (CEF))	Yes 	No 	
	Specify:	
		
*Note: Overlapping periods of professional experience will be counted only once; where additional periods of training and studies are accompanied by period of professional activity, only the latter shall be considered as professional experience; professional activities pursued part-time shall be calculated pro-rata, on the basis of the certified percentage of full-time hours worked
Declaration of honour (* Mandatory fields) 

I declare that the information provided above is, to my knowledge, true and complete.

Date/Signature

SELECTION GRID – Senior sampling and weighting expert
Last Name (in capitals): 
First name: 
Gender: 	Male: 
		Female: 
 (1)	University degree followed by	Yes 	No 	
	Specify:	
		
 (2)	A minimum of seven (7) years of professional experience, out of which a minimum of three (3) years’ experience of having participated in international social science-based statistics on minority groups or hard-to-reach populations.	Yes 	No 	
	Specify:	
		
 (3)	At least three (3) scientific publications (e.g. articles in peer reviewed academic journals or books, or peer reviewed book chapters, or books by academic publishers) on issues related to sampling or weighting or to applying sampling strategies for surveying ethnic minorities or immigrant populations, or hard-to-reach populations. 	Yes 	No 	
	Specify:	
		
 (4)	Excellent knowledge of English (Level C1 based on Common European Framework of Reference (CEF))	Yes 	No 	
	Specify:	
		
*Note: Overlapping periods of professional experience will be counted only once; where additional periods of training and studies are accompanied by period of professional activity, only the latter shall be considered as professional experience; professional activities pursued part-time shall be calculated pro-rata, on the basis of the certified percentage of full-time hours worked
Declaration of honour (* Mandatory fields) 

I declare that the information provided above is, to my knowledge, true and complete.

Date/Signature

SELECTION GRID – National Survey Experts (one per country)
Last Name (in capitals): 
First name: 
Gender: 	Male: 
		Female: 
 (1)	University degree followed by	Yes 	No 	
	Specify:	
		
 (2)	A minimum of three (3) years of professional experience in conducting social science-based survey research in the country for which they are responsible.	Yes 	No 	
	Specify:	
		
 (3)	Proven experience of managing at least two (2) quantitative representative survey research projects in the countries for which they are responsible.	Yes 	No 	
	Specify:	
		
 (4)	Good knowledge of English (minimum level B2)	Yes 	No 	
	Specify:	
		
*Note: Overlapping periods of professional experience will be counted only once; where additional periods of training and studies are accompanied by period of professional activity, only the latter shall be considered as professional experience; professional activities pursued part-time shall be calculated pro-rata, on the basis of the certified percentage of full-time hours worked
Declaration of honour (* Mandatory fields) 

I declare that the information provided above is, to my knowledge, true and complete.

Date/Signature

FORM D.2 – LIST OF PRINCIPAL SERVICES PROVIDED/SUPPLIES DELIVERED
Please complete a table using the format below to summarise the major relevant services provided relevant to this contract in the last 3 years. Please include one table per project.
The tenderers must accompany the list of principal services by certificates of satisfactory performance and completion of the services at least for at least the two (2) projects mentioned in Annex A – Tender Specifications.
Name of legal entity performing the project:		
Project name:		
Client:		
Country:		
Project value (euro):	<Total project value>	
Resources used:	<Total number of person days> or <Number of staff provided>	
Project duration :	From:                           To:                   Duration:   (months)	
Name of consortium partners, if any:		
Project Description:	<Please provide a summary of the project objectives and a description of the main tasks>

(if space not sufficient please adapt the table)

Signed (authorised signature) on behalf of the Tenderer
Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

FORM D.3 – STATEMENT ON ANNUAL AVERAGE MANPOWER 
Please provide a statement of the annual average manpower of the tenderer in the last three (3) years.

Statement on annual average manpower (average number of employees)	
Tenderer’s name	Current year -2	Current year -1	
Partner 1			
Partner 2			
Etc…			
Total			
(please add rows and columns if needed).] 

Signed (authorised signature) on behalf of the Tenderer
Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

SECTION E – FINANCIAL GUARANTEES

FORM E.1 – PRE-FINANCING GUARANTEE TEMPLATE
For information purposes only:
(To be completed on paper bearing the letterhead of the financial institution)
For the attention of
(Address of the Contracting Authority
referred to below as the 'Contracting Authority'
Title of contract: <Title of contract>
Identification number: [Publication reference]

Article 1 – Declaration on guarantee, amount and purpose
We, the undersigned [name and address of the financial institution or bank] (hereinafter referred to as "the Guarantor") hereby confirm that we give the European Union Agency for Fundamental Rights (hereinafter referred to as "the Agency"), an unconditional, irrevocable and independent first-demand guarantee consisting in the undertaking to pay to the Agency a sum equivalent to the amount of:
EUR [in figures: …] (in words: … EUR)
upon simple demand, for guarantee of the pre-financing(s) stipulated in the contract (N°/exact title, hereinafter referred to as the "contract") concluded between the Agency and [name and address], (hereinafter referred to as "the Contractor"). 
Article 2 – Execution of Guarantee
If the Agency gives notice that the Contractor has for any reason failed to reimburse pre-financings paid by the Agency, we, acting by order and for account of the Contractor, shall undertake to immediately pay up to the above amount, in EUR, without exception or objection, into [Option 1: a bank account designated by the Agency] [Option 2: the following bank account: (…)], on receipt of the first written request from the Agency sent by registered letter or by courier with acknowledgement of receipt. We shall inform the Agency in writing as soon as the payment has been made.
Article 3 – Obligations of the Guarantor
1.	We waive the right to require exhaustion of remedies against the Contractor, any right to withhold performance, any right of retention, any right of avoidance, any right to offset, and the right to assert any other claims which the Contractor may have against the Agency under the contract or in connection with it or on any other grounds.
2.	Our obligations under this guarantee shall not be affected by any arrangements or agreements made by the Agency with the Contractor which may concern his obligations under the contract.
3.	We shall undertake to immediately inform the Agency in writing, by registered letter or by courier with acknowledgement of receipt, in the event of a change of our legal status, ownership or address.
Article 4 – Date of Entry into force
This guarantee shall come into force upon its signature. If, on the date of its signature, the [first] pre-financing has not been paid to the Contractor, this guarantee shall enter into force on the date on which the Contractor receives the [first] pre-financing.
Article 5 – End Date and Conditions of Release
1. 	We may be released from this guarantee only with the Agency’s written consent.
2.	This guarantee shall expire on return of this original document by the Agency to our offices by registered letter or by courier with acknowledgement of receipt. 
3.	[Option 1: This must occur at the latest one month after the payment of the balance under the contract has been made or three months after the issuance of the corresponding recovery order.]
	[Option 2: This must occur at the latest during the month after the pre-financing under the contract has been cleared through interim payment[s].]
	[Option 3: This must occur in any case, at the latest, on (indicate a precise date).]

4.	After expiry, this guarantee shall become automatically null and void and no claim relating thereto shall be receivable for any reason whatsoever.
Article 6 – Applicable Law and Competent Jurisdiction
Option 1
1.	This guarantee shall be governed by and construed in accordance with the law applicable to the contract.
2.	The courts having jurisdiction for matters relating to the contract shall have sole jurisdiction in respect of matters relating to this guarantee.
Option 2
Any dispute concerning this guarantee shall be governed by and construed in accordance with the Law [of the country of establishment of the [Contractor][Bank]] and fall within the sole competence of the [corresponding national] Courts.
Article 7 - Assignment
The rights arising from this guarantee may not be assigned [without our written consent].

Done at [insert place], on [insert date]

__________________					[__________________]
[Signature/						[Signature/
Function at the Financial Institution/Bank]	Function at the Financial Institution/Bank]					

SECTION F – FINANCIAL OFFER

FORM F.1 – FINANCIAL OFFER TEMPLATE
[To be submitted in a separate sealed envelope clearly stating "Financial Offer" following the instructions laid down in Annex A – Tender Specifications]
D-SE-14-T07
Second European Union Minorities and Discrimination Survey (EU-MIDIS II)
IDENTIFICATION OF THE TENDERER:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
  Financial proposal in Euro 
(based on the information given in Annexes A and A.1 covering all costs)	
Concept	Price	
Phase I 		
Phase II		
TOTAL		
Signed (authorised signature) on behalf of the Tenderer

Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………