Part I/Selection of candidates

ANNEX A
STANDARD SUBMISSION FORM
Security and reception services
F-SE-14-T13	
SUBMITTED BY:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
1. PREAMBLE
Candidates are requested to include in their tenders all the information and documents requested in the forms attached, in accordance with Part I/Selection of candidates – Tender Specifications and the instructions below:
All forms must be dated, signed and stamped by a person authorised to sign on behalf of the candidate. 
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 candidate 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 candidate or by the partners in case of consortium or group of companies. 
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 F-SE-14-T13 (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 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 candidate intends to subcontract all or part of the performance of the Contract, if awarded. 
□	YES, the candidate intends to subcontract all or part of the performance of the Contract, if awarded.
□	NO, the candidate 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 candidate
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:
F-SE-14-T13
Declares hereby that, in case the contract is awarded to [name of the candidate], 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 [name of the signatory of this form, to be completed]:
•	in [his/her] own name (if the economic operator is a natural person)
or
•	representing (if the economic operator is a legal person and the declaration is signed by a director or person with powers of representation)
official name in full:
official legal form:
official address in full:
VAT registration number:
declares that he/she / the company or organisation that he/she represents 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 a subject of an administrative penalty for being guilty of misrepresentation in supplying the information required by the contracting authority as a condition of participation in a procurement procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts 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 – EVIDENCE OF PROFESSIONAL RISK INDEMNITY INSURANCE
Please attach evidence of professional risk indemnity insurance in the amount of € 1,000,000.00.

FORM C.2 – 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 the Tender Specifications.

FORM C.3 – STATEMENT OF ANNUAL TURNOVER
Please fill in the table below in accordance with the instructions provided in the  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).] 

Statement on annual turnover for services related to the contract  (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 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

SELECTION GRID – Security guard
(3 profiles needed)
Last Name (in capitals): 
First name: 
Gender: 	Male:  		Female: 
(1)	Secondary education level (minimum ISCED 2)	Yes 	No 	
	Specify:			
 (2)	Knowledge in English (level B1)	Yes 	No 	
	Specify			
	Knowledge in German (level B1)	Yes 	No 	
	Specify:	
 (3)	Minimum of two years’professional experience in security services in local area guarding	Yes 	No 	
	Specify:		
(4)	A certificate on “Brandschutzmeldeanlagen” and “Brandschutzwart” training	Yes         No 	
	Specify:		
(5)	Must have a certificate on first aid training
	Yes         No 	
	Specify:		
*Note: A given period of professional experience may 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 field) 

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

Date/Signature
SELECTION GRID – receptionist
(2 profiles needed)
Last Name (in capitals): 
First name: 
Gender: 	Male:  		Female: 
(1)	Secondary education level (minimum ISCED 2)	Yes 	No 	
	Specify:			
 (2)	Knowledge in English (level B1)	Yes 	No 	
	Specify			
	Knowledge in German (level B1)	Yes 	No 	
	Specify:	
 (3)	Minimum of two years’ professional experience in reception services	Yes 	No 	
	Specify:		
*Note: A given period of professional experience may 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 field) 

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

Date/Signature

FORM D.2 – LIST OF PRINCIPAL SERVICES PROVIDED
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 (3 projects).
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 AND MANAGERIAL STAFF
Please provide a statement of the annual average manpower and the number of managerial staff of the tender in the last three (3) years.

FORM D.4 – CERTIFICATE OF ENROLMENT 
Please provide a certificate of enrolment in a professional trade register