ANNEX C
STANDARD SUBMISSION FORM
OPEN CALL FOR TENDER F/SU/10/01
Provision of Food, Beverages and Household Material 	
IDENTIFICATION OF THE TENDERER:
Name of bidder: ……………………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
1.	GENERAL
Tenders must be clear and concise, with continuous page numbering, and assembled in a coherent fashion (e.g. bound or stapled, etc.). Since tenderers will be judged on the content of their written bids, these must make it clear that they are able to meet the requirements of the specifications.
Tenders must be written in one of the official languages of the European Union.
Tenders must include the following information:
-	all the information and documents requested by the Contracting Authority in order to assess the tender;
-	the price in euros;
-	one specimen signature of an authorised person (agent) on the legal entity form (Annex C.1.4), and a statement from the same person (agent) confirming the validity of the tender (preferably in blue ink);
-	the name of a contact person in relation to the submission of the bid.
If this is not included, the tender may be excluded from the procedure for the award of the Contract.

 2.	CHOICE OF LOT(S) 
Tenderers may apply for one or for both lots. Please indicate for which lot(s) you are submitting a tender.
Lot No	Title	Choice(s)	
1	Food and beverages		
2	Household materials		
(Please tick with an X where appropriate)

ANNEX C.1.1 - WRITTEN UNDERTAKING FROM THIRD ENTITIES
Applicable only if your tender includes several service providers as specified
in Annex A
Agreement / Power of Attorney
[To be filled-in separatedly for each Lot]
Model A
(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 …. ( the Contract ) to Company 1, Company 2, …, Company N ( the Group Members), based on the joint offer submitted by them on … ….. for the provision of the provision of services for … (the Services ).
2.	As co-signatories of the Contract, all the Group Members :
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 Supplies and/or the Services.
3.	To this effect, the Group Members designate Company X as Group Leader. [N.B.: The Group Leader has to be one of the Group Members]
4.	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 .[Provide details on bank, address, account number, etc.].
5.	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 Supplies or 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

Name
Function
Company

Name
Function
Company

Name
Function
Company 

ANNEX C.1.2 - WRITTEN UNDERTAKING FROM THIRD ENTITIES
Applicable only if your tender includes several service providers as specified
in Annex A 
Agreement / Power of Attorney
[To be filled-in separately for each Lot]
Model b
(CREATING THE GROUP AS SEPARATE ENTITY, APPOINTING A GROUP MANAGER AND GIVING A MANDATE TO HIM/HER)
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 …. ( the Contract ) to Company 1, Company 2, …, Company N ( the Group Members), based on the joint offer submitted by them on … ….. for the provision of the provision of services for … (the Services ).
2.	As co-signatories of the Contract, all the Group Members :
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 Supplies and/or the Services.
3.	To this effect, the Group Members have set up under the laws of ……. the Group ….. (the Group). The Group has the legal form of a .….. [Provide details on registration of the Group: VAT Number, Trade Register, etc.].
4.	Payments by the European Union Agency for Fundamental Rights related to the Supplies or the Services shall be made through the Group’s bank account . [Provide details on bank, address, account number, etc.].
5.	The Group Members appoint Mr/Ms ……. as Group Manager.
6.	The Group Members grant to the Group Manager all the necessary powers to act alone on their behalf in connection with the Supplies and/or the Services. This mandate involves in particular the following tasks :
a.	The Group Manager shall sign any contractual documents — including the Contract — and issue any invoices related to the Supplies or the Services on behalf of the Group Members.
b.	The Group Manager 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. He/she 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 of 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

Name
Function
Company

Name
Function
Company

Name
Function
Company

ANNEX C.1.3  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:	

ANNEX C.1.4  LEGAL ENTITY FORM

To be downloaded from http://ec.europa.eu/budget/execution/legal_entities_en.htm 
Please choose the appropriate form (legal entity form for either individuals, privatecompanies or publicentities) and attach the necessary supporting documents as required (see instructions in the file).

ANNEX C.1.5 FINANCIAL IDENTIFICATION FORM

To be downloaded from:  http://ec.europa.eu/budget/info_contract/ftiers_en.htm

ANNEX C.2.1 - EXCLUSION CRITERIA 

a.	The undersigned:
b.	Name of the company/organisation:………………………….
c.	Legal address:…………………………………………………..
d.	Registration number:……………………………………………
e.	VAT number:…………………………………………………….

Name of the signatory of this form (representative legally authorised to represent the candidate vis-à-vis third parties and acting on behalf of the aforementioned company or organisation):

declares on his honour that the company or organisation that he represents:
a)	is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors, has not suspended business activities, is not the subject of proceedings concerning those matters, and is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
b)	has not been convicted of an offence concerning professional conduct by a judgment which has the force of res judicata;
c)	has not been guilty of grave professional misconduct proven by any means which the contracting authorities can justify; 
d)	has fulfilled its obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the country in which it is established, or with those of the country of the contracting authority or those of the country where the contract is to be carried out; 
e)	has not been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the Communities' financial interests;
f)	has not been declared, following another procurement procedure or grant award procedure financed by the Community budget, to be in serious breach of contract for failure to comply with its contractual obligations.
In addition, the undersigned declares on his honour:
a)	that on the date of submission of the tender, the company or organisation he represents and the staff proposed for this tender are not subject to a conflict of interests in the context of this invitation to tender; he undertakes to inform the Contracting Authority without delay of any change to this situation after the date of submission of the tender.
b)	that the information provided to the Contracting Authority within the context of this invitation to tender is accurate, sincere and complete.
Fullname:……………………………………..Date:…………………………………………

Signature:…………………………………….. 

ANNEX C.2.2 - SOLEMN DECLARATION
I, the undersigned, (surname, first name) .......................................... acting in my capacity as (position) ......................................... with (name of institution) .............................................., hereby solemnly declare that (name of tendering company) ...................................................................................................................:
1)	have not been guilty of grave professional misconduct proven by any means which the contracting authority can justify;
2)	following another procurement procedure or grant award procedure financed by the Community budget, have not been declared to be in serious breach of contract for failure to comply with their contractual obligations.
3)	is not guilty of serious misrepresentation in supplying the information required by the FRA;
4)	do not have any 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 affinities, family or emotional ties, or any other relevant connection or shared interest;
5)	will inform the contracting authority, without delay, of any situation constituting a conflict of interest or which could give rise to a conflict of interest;
6)	have not made and will not make any offer of any type whatsoever from which an advantage can be derived under the contract;
7)	have not granted and will not grant, have not sought and will not seek, have not attempted and will not attempt to obtain, and have not accepted and will not accept, any advantage, financial or in kind, to or from any party whatsoever, constituting an illegal practice or involving corruption, either directly or indirectly, as an incentive or reward relating to the award of the contract.
and that it is not therefore subject to any of the grounds for exclusion provided for in Tender Specifications F/SU/10/01 of the European Union Agency for Fundamental Rights.
The Agency reserves the right to check the above information.
Done at ................................... on ................................ .
Surname, first name:	...........................................................
Signature:...........................................................

 
ANNEX C.3  - FINANCIAL PROPOSAL
Open call for tenders
F/SU/10/01
Provision of Food, Beverages and Household Material 
[To be filled-in separatedly for each Lot]
IDENTIFICATION OF THE TENDERER:
Name of bidder: ……………………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………

Financial proposal in Euro 
(based on the information given in Annex A.1 covering all costs)	
Prices shall be expressed in euro. Prices per item need to be specified as follows:
Lot 1: Food and beverages
Food 
Item No.	Description	Quantity	Unit price	Discount per item	Total Price 
(including discount)	
1	Coffee 500gr “Jacobs Monarch”, finely ground or equivalent	12				
2	“Twinings Earl Grey” 50Tb or equivalent	1				
3	Coffee filter “Melitta” 1 x 4 “unbleached” 1 pack or equivalent	6				
4	Lump sugar “Wiener Zucker” 1 pack or equivalent	10				
5	“Maresi” Bottle 500g or equivalent	12				
6	Chocolate cookies “Bahlsen Chokini” packing with approx. 125g or equivalent	12				
7	Cookies – “Manner Haselnuss - Röllchen” 1 pack – 250g or equivalent	12				
8	Peanut snack “Ueltje” 1 packing 1000g or equivalent	1				
9	Cashews snack “Ueltje” 1 packing 100g or equivalent	1				

Beverages										
Item No.	Description	Quantity	Unit price	Discount per item	Total Price 
(including discount)	
10	“Römerquelle classic” - mineral water  glass bottle 0,33 litre or equivalent	6				
11	Mineral water – “Römerquelle” plastic bottle 0,5 litre (still) or equivalent	6				
12	Sekt 1 litre “Prosecco Pisani” or equivalent	6				
13	Orange juice “Rauch” packing with 1 litre or equivalent	6				
14	Apple juice “Rauch” packing with 1 litre or equivalent	6				

Delivery costs
Item No.	Description	Discount	Total Price 
(including discount)	
15	Next working day (between 13:00 and 17:00) delivery cost for orders more than €200.00.			
Lot 2: Household materials
Household items	
Item No	Description	Quantity	Unit price	Discount per item	Total Price 
(including discount)	
16	“Calgonit” powerball Tabs for the dish washer approx. 60 stk. or equivalent	6				
17	“Pril” dish liquid “Geschirrspülmittel” bottle 750 ml or equivalent	6				
18	“Cosy” toilet paper – 3 paper “3 lagig” packing with 10 pieces or equivalent	6				
19	“Swirl” garbage bag  35 litre packing with 25 pieces - white or equivalent	6				
Delivery costs 
Item No.	Description	Discount	Total Price 
(including discount)	
20	Next working day (between 13:00 and 17:00) delivery cost for orders more than €200.00.			

1.	The official price list will be updated every _______________.
2.	Please give precise indications as how the official price list will be made available to the Contracting Authority.
______________________________________________________________
3.	Please attach a printed version of your company’s official price list valid at the day of the deadline for submitting tenders.

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

ANNEX C.5.1 – STATEMENT ON ANNUAL OVERALL TURNOVER
 As stated in Section 18.2.1.a) of Annex A – Tender Specifications

Statement on annual overall turnover (in EURO)	
YEAR	2008	2009	
TURNOVER			

Signed (authorised signature) on behalf of the Tenderer

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

ANNEX C.5.2 – BALANCE SHEETS
 
As stated in Section 18.2.1.b) of Annex A – Tender Specifications

ANNEX C.6.1 – PROOF OF ENROLLMENT IN THE RELEVANT PROFESSIONAL REGISTER
(Technical and professional capacity, as specified under section 18.2.2.a) in the Tender Specifications Annex A) 

ANNEX C.7 - Administrative details	
1.	Person to be contacted regarding this Tender:	
a.	Name of company or ogorganisation name		
b.	Surname		
c.	First name		
d.	Title (Dr, Mr, Mrs, Ms etc.) 		
e.	Position (e.g. director, etc.) 		
f.	Telephone number		
g.	Fax number		
h.	Email address		
i.	Address		
2.	Person authorised to sign contracts on behalf of the tenderer:	
a.	Name of company or ogorganisation name		
b.	Surname		
c.	First name		
d.	Title (Dr, Mr, Mrs, Ms etc.)		
e.	Position (e.g. director, etc.)		
f.	Telephone number		
g.	Fax number		
h.	Email address		
Signed (authorised signature) on behalf of the Tenderer
Full name:……………………………..  Date:………………………… 
Signature:………………………..	Stamp:…………………………