ANNEX C
STANDARD SUBMISSION FORM
FRA Violence Against Women Survey
D-SE-11-T04	
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). When subcontracting exceeds 20% of the total contract value, each subcontractor must also sign the Declaration of Honour.
•	Each proposed 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-11-T04 ( the Contract ) to Company 1, Company 2, …, Company N ( the Group Members), based on the joint offer submitted by them on [complete] 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 Supplies and/or the Services.
2.	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]
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 .[Provide details on bank, address, account number, etc.].
4.	The Group Members grant to the Group Leader all the necessary powers to act on their behalf in connection with the Supplies and/or 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 Supplies and/or the Services to be provided under the Contract. It shall co-ordinate the provision of the Supplies and/or 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 Supplies and/or 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-11-T04
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 [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:
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 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 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 Union’s financial interests;
f)	is not a subject of the administrative penalty for being guilty of misrepresentation in supplying the information required by the contracting authority as a condition of participation in the procurement procedure or failing to supply an information, or being declared to be in serious breach of his obligation under contract covered by the budget.
In addition, the undersigned declares on their honour:
g)	they have 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 affinities, family or emotional ties or any other relevant connection or shared interest;
h)	they 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)	they have not made and will not make any offer of any type whatsoever from which an advantage can be derived under the contract;
j)	they 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 award of the contract.
k) that the information provided to the Commission within the context of this invitation to tender is accurate, sincere and complete.
l) that in case of award of contract, they shall provide the evidence that they are not in any of the situations described in points a, b, d, e above.
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.
By signing this form, the undersigned acknowledges that they have been acquainted with the administrative and financial penalties described under art 133 and 134 b of the Implementing Rules (Commission Regulation 2342/2002 of 23/12/02), which may be applied if any of the declarations or information provided prove to be false.

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)
FROM 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
The tenderer shall include evidence of the educational and professional qualifications described in the CVs of the Project Manager and the Senior Research Expert in the form of diplomas and/or employers’ certificates stating starting and end dates of employment.
Note: Please complete the selection grids below summarising the experience of the CVs for the experts proposed in accordance with the requirements set up in Annex A.1 – Technical Specifications.

SELECTION GRID – Project manager
Last Name (in capitals): 
First name: 
Gender: 	Male: 
			Female: 
 (1)	University degree	Yes 	No 	
		Years:
Specify:	
		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 	
		Years:
Specify:	
		Specify:	
 (3)	Proven experience in research management, as manager or coordinator of at least two (2) international research projects, each project involving at least three countries	Yes 	No 	
		Years:
Specify:	
		Specify:	
 (4)	Excellent knowledge of English (Level C1 based on Common European Framework of Reference (CEF))	Yes 	No 	
		Level:
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 fields) 

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

Date/Signature

SELECTION GRID – Senior Research Expert
Last Name (in capitals): 
First name: 
Gender: 	Male: 
			Female: 
 (1)	University degree	Yes 	No 	
		Years:
Specify:	
		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 research on violence against women	Yes 	No 	
		Years:
Specify:	
		Specify:	
 (3)	At least three (3) scientific publications (e.g. articles in peer reviewed academic journals or books or peer reviewed books by academic publishers) on violence against women. 	Yes 	No 	
		Years:
Specify:	
		Specify:	
 (4)	Excellent knowledge of English (Level C1 based on Common European Framework of Reference (CEF))	Yes 	No 	
		Level:
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 fields) 

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

SELECTION GRID –Research Experts
Last Name (in capitals): 
First name: 
Gender: 	Male: 
			Female: 
 (1)	University degree	Yes 	No 	
		Years:
Specify:	
		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 	
		Years:
Specify:	
		Specify:	
 (3)	Proven experience of managing at least two (2) quantitative survey research projects in the countries for which they are responsible.	Yes 	No 	
		Years:
Specify:	
		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 fields) 

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

FORM D.2 – LIST OF PRINCIPAL SERVICES PROVIDED/SUPPLIES DELIVERED
Please complete a table using the format below to summarise the mayor relevant services provided/supplies delivered relevant to this contract in the last 3 years. Please include one table per project.
The tenderers must accompany the list of principal services or supplies by certificates of satisfactory performance and completion of the services or supplies.
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 – DESCRIPTION OF QUALITY MEASURES
Please include a description of the measures that will be employed to ensure the quality control of the services during project implementation

Signed (authorised signature) on behalf of the Tenderer

Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………
SECTION E – FINANCIAL GUARANTEES
PRE-FINANCING GUARANTEE FORM
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 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 Contracting Authority 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-11-T04
FRA Violence Against Women Survey
IDENTIFICATION OF THE TENDERER:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
A. Financial proposal in Euro
(based on the information given in Annexes A and A.1 covering all costs)	
Concept	Price	
Phase 1		
Phase 2		
TOTAL		

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