PFI Procurement. Centralisation and Modernisation of Acute Services on the Broomfield Hospital Site

Transcription

1 PFI Procurement Centralisation and Modernisation of Acute Services on the Broomfield Hospital Site Pre-Qualification Questionnaire January 2003 Version 1.00

2 INTRODUCTION 1 Responses 2 Layout of PQQ 3 SECTION A 4 Consortium Details 4 Project Resources 6 Working together 7 Conflicts of Interest 7 Shareholding 8 Financial Capacity 8 Funding 9 SECTION B 10 Information on the Construction Contractor 10 Quality assurance / Health & Safety / Environmental 13 Employment 14 SECTION C 15 Information on the FM Service Provider(s) 15 Quality assurance/health & Safety/Environmental 19 Employment 20 SECTION D 22 Information on Advisers 22 SECTION E 24 Declaration 24

3 Introduction This Pre-Qualification Questionnaire (PQQ) assesses the technical capability and capacity, financial and economic strengths of organisations expressing an interest in bidding for the Project. The Memorandum of Information (MOI) included with this PQQ provides information about the NHS Trust, its Commissioners and the Project. In this document the Consortium refers to the organisation or group of shareholding organisations that make up a bidding project consortium, that would ultimately become Project Co contracting with the NHS Trust. A Member Organisation is the term used to describe the individual organisations that constitute the Consortium. This would usually include the Construction and Facilities Management contractor. A Relevant Organisation is the term used to describe all organisations connected with the bid. This includes: the shareholders, including Third Party Equity Providers the Designer(s) the Advisers; and for the avoidance of doubt, the Member Organisations. The Trust reserves the right to require some or all Consortia to clarify their submissions in writing. Any such request shall be made in writing to the Consortium or its nominated representative. Failure to respond adequately may result in that Consortium not qualifying. The Trust will wish to be satisfied that, within the parameters of Regulations of the 1993 Public Services Contracts Regulations, each Consortium selected has the appropriate qualities and resources to undertake the Project and successfully meet the necessary requirements to design, build, finance and operate the relevant services within the hospital. The Trust reserves the right to reject any Consortium that fails to comply fully with the requirements of the selection process set out in this document or which is guilty of a serious misrepresentation in supplying any information requested. It is expected that qualifying Consortia and Relevant Organisations will confirm that they will not collaborate with other Consortia. Consortia and Relevant Organisations must complete all sections of the PQQ, and supply any additional information as required. Where a section is not applicable this should be clearly stated. Failure to complete the PQQ will automatically and immediately disqualify the Consortium from this Project, and the NHS Trust will undertake no further evaluation of the PQQ. Page 1

4 The layout of the PQQ has been designed to enable bidders to complete it as easily as possible and is organised as follows: Section A : details of the Consortium as a whole, including the financial standing of its component Relevant Organisations; Sections B D : details which are specific to each Relevant Organisation (i.e. construction, FM and so forth). The inclusion of an executive summary or a statement of reasons for selection is not required and will not be considered in the evaluation of the PQQ. Responses Consortia are requested to provide two paper copies and one CD copy of their submission. The CD is to include any necessary reports and accounts, which should be in pdf format or Microsoft Word 97 (or earlier). Responses should be sent to: Andrew Pike Chief Executive Mid Essex Hospital Services NHS Trust Broomfield Court Pudding Wood Lane Broomfield Chelmsford CM1 7WE Completed responses are requested by 12 noon on Wednesday 12 th February For the purposes of proof of receipt, the date and time of the receipt of the printed copy will be recorded. Page 2

5 Layout of PQQ Section Requirement A. Details of the Consortium, its internal organisation and relationships between Relevant Organisations, including their roles and key individuals. Details of the Consortium s shareholders (or potential shareholders). Financial capacity (including last 3 years audited accounts) Details of experience in raising finance B. Information on the Consortium s Construction Contractor. Background information and legal form PFI and other relevant technical experience and references Quality, Health & Safety, and environmental accreditation C. Information on the Consortium s Facilities Management Service Provider(s), including Equipment, IM&T, and Third Party Income Generation Background information and legal form PFI and other relevant technical experience and references Quality, Health & Safety, and environmental accreditation Employment and Pension information D. Information on the Consortium s Advisers, including Designers and Technical, Legal, Financial, and Other Background information and legal form PFI and other relevant experience Quality accreditation E Declaration Page 3

6 Section A Consortium Details To be completed on behalf of all Member Organisations making up the Consortium A1 Consortium Name: Address: Telephone: Fax: Consortium s Authorised Representative (person for contact purposes) Name: Address: Telephone: Fax: Declaration that must be signed by the Consortium is at the end of the document in Section E A2 Status of Consortium (a) Single Candidate Consortium Other joint venture (b) Already a Limited Company To be incorporated Not to be incorporated Page 4

7 A3 Where Consortium is already a limited company: Registered Name Current Trading Name: Previous Trading Names (if different) Registered Address (if different to A1) Telephone (if different to A1) Fax (if different to A1) (if different to A1) Registered No.: Year of Registration: Country of Registration: A4 Indicate the Relevant Organisations that will undertake the following roles on the Project Role Shareholding Companies Construction Contractor Hard FM Service Provider(s) Soft FM Service Provider(s), including Third Party Income Service Provider(s) Equipment Provider(s) IM&T Provider(s) Designer(s) and Technical Adviser(s), including IM&T Legal Adviser Financial Adviser Other Adviser(s) Complete Section A B C D Name of organisations (full title) A5 A6 Provide an organisation chart showing internal relationships between the Consortium and Member and Relevant Organisations. State whether membership, roles and responsibilities will change during the PFI procurement, design, construction and operational phases of the contract. Provide a statement that there are no grounds applicable to any Relevant Organisation pursuant to which a Bidder may be rejected under Regulation 14 of the Public Services Contracts Regulations Page 5

8 Project Resources A7 Provide the names of the key team members (and their employers) who are likely to be involved in the management structure of the bid Role Name Company/firm Bid manager Shareholder representative(s) Construction contractor representative(s) Hard FM Service Provider representative(s) Soft FM Service Provider representative(s), including Third Party Income Service Provider(s) (where relevant) Equipment Provider representative(s) (where relevant) IM&T Provider representative(s) (where relevant) Designer(s) and Technical Adviser(s) Legal Adviser(s) Financial Adviser(s) Other(s) Attach CVs for the people named above. The number of CVs is not to exceed 20 and each CV should include details relevant to the procurement and should be no more than one page in length. A8 Include a statement providing details of the capacity of key persons listed in A7 to allocate sufficient time to the project. Identify any existing or future potential time conflicts for each key person, particularly those prior to financial close. Name Other Projects Involved In Dates of Other Project Involvements Comments Page 6

9 Working together A9 Provide details of previous and current experience where the Consortium or any combination of Relevant Organisations have been or are involved in health care or other relevant Projects (PFI or other) in the last three years. Provide these details in 2 sections: Experience where the Consortium has previously been or is currently involved. Experience where a combination of only some of the Relevant Organisations have previously been or is currently involved. Provide details where any new relationships are being formed to create a Consortium. Projects should be listed in order of decreasing capital value. If any projects are listed as withdrawn, bidders should set out separately why they withdrew. Project Name and Client name Capital Cost m Healthcare PFI/ Other PFI/ Non- PFI Healthcare Consortium/ Relevant Organisation s involved Status of Project (PQQ/ ITN/ Pref. Bidder/ Build/ Operate/ Cancelled/ Withdrawn (at which stage) Dates Involved What Was Your Role A10 Provide a statement of any material non-employment related litigation or other legal proceedings (pending, threatened or determined) relating to any of the projects in A9 within the last three years that may affect the Consortium s ability to deliver this Project or any of the projects listed. Exclude County Court proceedings and Debt collection below a threshold of 5,000. The response should highlight the Relevant Organisations concerned (including Third Party Equity providers) A11 Provide details including contact name, address, telephone and fax number, and of three Client references from projects listed in A9. Conflicts of Interest A12 Identify any potential conflicts of interest that may arise if the Consortium were to be selected (taking into account all Relevant Organisations), and how these will be dealt with. In particular, please deal with any potential conflicts where: a Relevant Organisation has carried or is carrying out any work for the NHS Trust in the last 3 years a Relevant Organisation is potentially providing services for more than one prospective Bidder in respect of this Project or procurement process Page 7

10 Shareholding A13 Responses should identify each shareholder or potential shareholder listed at A4. Name of Shareholder Estimated initial equity share (of total Project funding requirements) (or m equity stake) A14 Which Relevant Organisation(s) will be responsible for authorising the investment of equity in the Consortium? Financial Capacity A15 All Relevant Organisations (including Third Party Equity Providers) should supply the following as Annex A15. Where that organisation will provide equity supported by a guarantee, indemnity or undertaking from a parent company or ultimate holding company, then the information requested in this section must be supplied both for the Relevant Organisation and its parent or ultimate holding company. Copies of the last three years audited accounts. The latest set of which should be for an accounting period ending no earlier than 12 months before the date of submission of this PQQ. If accounts are not available then an explanation should be provided. Evaluation will include, but not be limited to, consideration of contingent liabilities, provisions, rights issues, acquisitions and disposals, off-balance sheet finance, gearing, liquidity. Any published interim accounts (for public limited companies) or management accounts (for non-plc s) relating to periods after the latest audited accounts. Cash flow statements for the last three financial years, prepared in accordance with Financial Reporting Standard 1 (Revised). Details of any event between the date on which the latest set of accounts was authorised for issue and the date of the submission of this PQQ that, had the accounts not been authorised for issue until this submission date, would have required to be adjusted for, or disclosed in accordance with, International Accounting Standard 10. Statement of overall turnover and the turnover for PFI type projects for the previous three years Copies of any company announcements made to the authorities of the stock exchange, market or bourse on which the stocks or shares of the company are publicly traded, since the date of publication of the latest set of accounts. Page 8

11 Funding A16 Provide details of the Consortium s experience in raising finance on Project Finance and PFI-type projects over the last three years. Project Name Finance raised m Name(s) of lenders Healthcare PFI/Other PFI/ Other relevant Type of finance (bank/ bond) Date of Financial Close A17 A18 The Consortium should set out its preferred approach to the selection of a lender. If one has been selected already, the Consortium should set out how the lender was appointed and why it should be preferred. Bidders should signify their willingness to undertake a funding competition, and if not, why not. Each Relevant Organisation (including any Third Party Equity Providers identified in A15) should provide details of their experience in providing equity on PFI-type projects over the last three years. Project Name Equity provided m Healthcare PFI/Other PFI/ Other relevant Date of Financial Close A19 The Consortium should signify its acceptance of the principles contained within the Standard Form Contract and Standard Form Payment Mechanism. Page 9

12 Section B Information on the Construction Contractor To be completed by the Contractor or each contractor making up a Construction Joint Venture. Where there is more than one Contractor, the section will be evaluated weighted approximately by each Contractor s proportion of the capital value. B1 Details of Organisation Registered Name: Current Trading Name: Previous Trading Names (if different): Registered Address: Telephone: Fax: Registered No: Year of Registration: Country of Registration: B2 Type of Organisation Private Limited Company Partnership Other (please specify) Public Limited Company UK registered branch of overseas company B3 Parent or Holding Companies If the organisation named in B1 is a subsidiary of another organisation, please : Name the parent or holding company and indicate what interest the parent of holding company has in the company in B1 If the parent company will be providing a guarantee to support the obligations of the named contractor in B1, provide a statement from the parent company stating that it is, in principle, prepared to support the contracting company, including the provision of performance guarantees; Provide the information required in B9 and B10. B4 Name any other known sub-contractors and their roles, and if applicable areas in which you envisage using other as yet unidentified subcontractors for this Page 10

13 Project. Where sub-contractors are key to the Project (in the view of the bidder, or if highlighted as such by the Trust in its Memorandum of Information), they should be identified as separate Relevant Organisations and the appropriate sections of this PQQ completed. B5 Healthcare PFI Experience Provide details of previous experience of Healthcare PFI in the last three years. Projects should be listed in order of decreasing capital value. Projects that are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Capital Cost m for Your Element of the Scheme Status of project Dates of involvement Organisation s role B6 Other PFI Experience Provide details of previous experience of non-healthcare PFI in the last three years. Projects should be listed in order of decreasing capital value. Projects that are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Capital Cost m Status of project Dates of involvement Organisation s role B7 Healthcare Experience (non PFI) Provide details of healthcare projects undertaken in the last three years including the extent of the services or works for which the organisation was responsible and the dates of the organisation s involvement. Projects that are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Capital Cost m Status of project Dates of involvement Organisation s role Page 11

14 B8 Other Relevant Experience Provide any evidence of non-health projects and non-pfi projects that demonstrate the organisation s experience in the last three years relevant to its proposed role in the PFI project. Projects that are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Capital Cost m Status of project Dates of involvement Organisation s role B9 B10 B11 Give details of any projects for contracts in excess of 1 million in which the organisation has been involved where there has been a failure to complete (by the scheduled completion date) or where there have been claims for damages, or where damages have been deducted or reserved within the last three years and where the amount of damages (claimed or ordered) is greater than 100,000. Include, for each project, reasons for the failure or claim. Provide a statement of any material non-employment related litigation (pending, threatened or determined) or other legal proceedings against the organisation within the last three years that may affect the Consortium s ability to deliver this project or any of the projects in B5 to B8. Exclude Country Court proceedings and debt collection below a threshold of 5,000. Provide details including contact name, address, telephone and fax number, and of three Client references from projects listed in B5 to B8. Page 12

15 Quality assurance / Health & Safety / Environmental B12 B13 Does the organisation have, or is it seeking, certification under International, European, British or other quality standards (e.g. BS5750, BS EN ISO 9000 etc)? State the relevant quality standards. Enclose copies of the written statement (as required by section 2(3) of the Health and Safety at Work Act 1974 and regulation 4 of the Management of Health and Safety at Work Regulations 1992) (or EU member state equivalent) of the Relevant Organisation s General policy on health and safety at work Allocation of organisational responsibilities at work Adopted preventive and protective measures, such as safety codes of practice and safety instructions, relevant to the type of projects proposed, and its adopted arrangements for the effective planning, control, monitoring and review of these preventive and protective measures. B14 B15 B16 B17 B18 B19 State the name and status of the person responsible for the implementation of the organisation s Health and Safety policy. Give brief details of safety audits and inspections carried out in similar activities to this Project, including details of frequency, whether records are kept and who is responsible for any remedial action. State (and provide brief details if necessary) whether any Prohibition Notices or improvement Notices (or EU equivalent) have been served on the organisation or any of its directors/managers in the last three years with respect to health and safety or fire safety issues in relation to PFI type projects, building projects and facilities management contracts or similar activities. State the number of fatal accidents and major injury accidents (requiring immediate notification to the relevant Health and Safety enforcing authority) which have occurred to (a) the organisation s employees over the past three years arising from the conduct of activities similar to those covered by PFI type projects, building projects or similar activities; (b) people other than its employees (e.g. members of the public) over the past three years arising from the conduct of such activities. State whether there is or will be an environmental policy and/or green policy for any service likely to be provided in the proposed Project. If so, please state which part of the service the policy relates to. Please state whether the Relevant Organisation operates an Environmental Management System (EMS) and if so, whether the EMS meets the standards in BS7750, ISO14001, EMAS or equivalent. Page 13

16 Employment B20 The organisation should provide: details of its policies for the training and supervision of staff. This should include, but not be limited to, training and supervision on health and safety matters; and details of its policies for the promotion, delivery and monitoring of Equal Opportunities. B21 How many staff are currently employed directly in the field of construction generally and PFI, specifically. Staff Type All All PFI only PFI only Full Time Part Time Full Time Part Time Managerial/ Supervisory Operational (Permanent) Operational (Casual) Total B22 Provide a statement of your organisation s average annual manpower over the past three years. Staff Type Managerial/ Supervisory Operational (Permanent) Operational (Casual) Total B23 Provide details of staff turnover as a percentage of the workforce for the last three years. Staff Type Managerial/ Supervisory Operational (Permanent) Operational (Casual) Total Turnover (%) Page 14

17 Section C Information on the FM Service Provider(s) All the FM Service Provider(s) identified at A4 should complete this section separately. Where there is more than one Service Provider completing this section, the evaluation (as determined by the Trust) will weight the responses between FM provider(s) IM&T or equipment providers to reflect the unique requirements of the Project. C1 Details of Organisation Registered Name: Current Trading Name: Previous Trading Names (if different): Registered Address: Telephone: Fax: Registered No: Year of Registration: Country of Registration: C2 Type of Organisation Private Limited Company Partnership Other (please specify) Public Limited Company UK registered branch of overseas company C3 Parent or Holding Companies If the organisation named in C1 is a subsidiary of another organisation, please: Name the parent or holding company and indicate what interest the parent of holding company has in the company in C1 If the parent company will be providing a guarantee to support the obligations of the named contractor in C1, provide a statement from the parent company stating that it is, in principle, prepared to support the contracting company, including the provision of performance guarantees; Provide the information required in C9 and C10. Page 15

18 C4 Indicate which services are to be provided by the Relevant Organisation, and which will be sub-contracted. Name any other known sub-contractors, and state the proposed method of selection for sub-contractors not yet identified. Where subcontractors are either critical or material to the Project (in the view of the bidder or are highlighted as such in the Trust s Memorandum of Information, they should be identified as separate Relevant Organisations and the appropriate sections of this PQQ completed. Service Property & Building Maintenance Grounds & Garden Maintenance Medical Equipment (specify) IM&T (specify) Energy management Energy & Utilities Waste Disposal Pest Control Security Sterile Supplies Car Parking Residential Accommodation Crèche/Nursery Stores Reception Non-emergency Patient Transport Postal Services Courier Services Telecoms Domestic Services Catering Laundry & Linen Services Portering Retail services (specify) Other (specify) Directly provided Subcontracted (give name if known) Not provided Third Party Income (indicate if profit or revenue sharing agreement) Page 16

19 C5 Healthcare PFI Experience Provide details of previous experience of Healthcare PFI (including IM&T) in the last three years. Projects should be listed in order of decreasing annual contract value. For each service provided, indicate whether that service was directly provided (D), sub-contracted (S), and/or generated third party income (3). Projects which are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Annual Contract Value m Status of project Dates of involvement Services provided (using headings from list in C4 with indication of how provided (D/S/3)) C6 Other PFI Experience Provide details of previous experience of non-healthcare PFI (including IM&T) in the last three years. Projects should be listed in order of decreasing annual contract value. For each service provided, indicate whether that service was directly provided (D), sub-contracted (S), and/or generated third party income (3). Projects which are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Annual Contract Value m Status of project Dates of involvement Services provided (using headings from list in C4 with indication of how provided (D/S/3)) C7 Healthcare Experience (non PFI) Provide details of healthcare projects (including IM&T) undertaken in the last three years including the extent of the services or works for which the organisation was responsible and the dates of the organisation s involvement. For each service provided, indicate whether that service was directly provided (D), sub-contracted (S), and/or generated third party income (3). Projects which are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Page 17

20 Project Name and Client Name Provide name of main Contractor if you were subcontracted Annual Contract Value m Status of project Dates of involvement Services provided (using headings from list in C4 with indication of how provided (D/S/3)) C8 Other Relevant Experience Provide any evidence of non-health projects and non-pfi projects (including IM&T) that demonstrate the organisation s experience in the last three years relevant to its proposed role in the PFI project. For each service provided, indicate whether that service was directly provided (D), sub-contracted (S), and/or generated third party income (3). Projects that are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Provide name of main Contractor if you were subcontracted Annual Contract Value m Status of project Dates of involvement Services provided (using headings from list in C4 with indication of how provided (D/S/3)) C9 C10 C11 Give details of any projects for contracts in excess of 1 million in which the organisation has been involved where there has been a failure to complete (by the scheduled completion date) or where there have been claims for damages, or where damages have been deducted or reserved within the last three years and where the amount of damages (claimed or ordered) is greater than 100,000. Include, for each project, reasons for the failure or claim. Provide a statement of any material non-employment related litigation (pending, threatened or determined) or other legal proceedings against the organisation within the last three years that may affect the Consortium s ability to deliver this project or any of the projects in C5 to C8. Exclude Country Court proceedings and debt collection below a threshold of 5,000. Provide details including contact name, address, telephone and fax number, and of three Client references from projects listed in C5 to C8. Page 18

21 Quality assurance/health & Safety/Environmental C12 C13 C14 C15 C16 C17 C18 C19 Does the organisation have, or is it seeking, certification under International, European, British or other quality standards (e.g. BS5750, BS EN ISO 9000 etc)? State the relevant quality standards. Enclose copies of the written statement (as required by section 2(3) of the Health and Safety at Work Act 1974 and regulation 4 of the Management of Health and Safety at Work Regulations 1992) (or EU member state equivalent) of the Relevant Organisation s General policy on health and safety at work Allocation of organisational responsibilities at work Adopted preventive and protective measures, such as safety codes of practice and safety instructions, relevant to the type of projects proposed, and its adopted arrangements for the effective planning, control, monitoring and review of these preventive and protective measures. State the name and status of the person responsible for the implementation of the organisation s Health and Safety policy. Give brief details of safety audits and inspections carried out in similar activities to this Project, including details of frequency, whether records are kept and who is responsible for any remedial action. State (and provide brief details if necessary) whether any Prohibition Notices or Improvement Notices (or EU equivalent) have been served on the organisation or any of its directors/managers in the last three years with respect to health and safety or fire safety issues in relation to PFI type projects, building projects and facilities management contracts or similar activities. State the number of fatal accidents and major injury accidents (requiring immediate notification to the relevant Health and Safety enforcing authority) which have occurred to (a) the organisation s employees over the past three years arising from the conduct of activities similar to those covered by PFI type projects, facilities management contracts or similar activities; (b) people other than its employees (e.g. members of the public) over the past three years arising from the conduct of such activities. State whether there is or will be an environmental policy and/or green policy for any service likely to be provided in the proposed Project. If so, please state which part of the service the policy relates to. Please state whether the Relevant Organisation operates an Environmental Management System (EMS) and if so, whether the EMS meets the standards in BS7750, ISO14001, EMAS or equivalent. Page 19

22 Employment C20 C21 The organisation should provide: details of its policies for the training and supervision of staff. This should include, but not be limited to training and supervision on health and safety matters; and details of its policies for the promotion, delivery and monitoring of Equal Opportunities. How many staff are currently employed directly in the field of facilities management generally and PFI, specifically. Staff Type All All PFI only PFI only Full Time Part Time Full Time Part Time Managerial/ Supervisory Operational (Permanent) Operational (Casual) Total C22 Provide a statement of your organisation s average annual manpower over the past three years. Staff Type Managerial/ Supervisory Operational (Permanent) Operational (Casual) Total C23 Provide details of staff turnover as a percentage of the workforce for the last three years. Staff Type Managerial/ Supervisory Operational (Permanent) Operational (Casual) Total Turnover (%) C24 Provide details of experience of transferring staff in relevant projects in C5 to C8. Project (from C5 to C8) Number of staff transferred under TUPE (or EU Trade Union recognition continued for transferred staff Trade Union involvement in procurement process (e.g. interview Broadly comparable pension provided certified by Page 20

23 equivalent) bidders) GAD C25 C26 C27 Provide an assurance that, where a Relevant Organisation does not currently provide a GAD-certified broadly comparable pension scheme, it will do so if applicable (subject to current Government policy on staff transfer). Provide a statement accepting the principles of the Retention of Employment model for the five trades (domestics, portering, security, laundry & linen and catering) and willingness to work within the terms contained within the Standard Form Project Agreement. Provide a statement of any material employment related litigation or other legal proceedings (pending, threatened or determined) within the last three years that may impact on the ability of the organisation to deliver this or any of the projects listed in C5 C8. Page 21

24 Section D Information on Advisers All the Advisers identified at A4 should complete this section separately (the Designer(s) and Technical Adviser(s) are intended to include the companies providing the following services: Architectural Design; Structural Engineering Design; Civil Engineering Design; Mechanical and Electrical Engineering; Quantity Surveying; Health Facilities Planning etc). D1 Details of Organisation Registered Name: Current Trading Name: Previous Trading Names (if different): Registered Address: Telephone: Fax: Registered No: Year of Registration: Country of Registration: Advisory Role for this Scheme: D2 Type of Organisation Private Limited Company Partnership Other (please specify) Public Limited Company UK registered branch of overseas company D3 Healthcare PFI Experience Provide details of previous experience of Healthcare PFI in the last three years. Projects should be listed in order of decreasing capital value. Please limit to 12 entries. Projects that are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Capital Cost m Status of project Dates of involvement Services Provided/ Company s role Page 22

25 D4 Other PFI Experience Provide details of previous experience of non-healthcare PFI in the last three years. Projects should be listed in order of decreasing capital value. Please limit to 12 entries. Projects which are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Capital Cost m Status of project Dates of involvement Services Provided/ Company s role D5 Healthcare Experience (non PFI) Provide details of healthcare projects undertaken in the last three years including the extent of the services or works for which the organisation was responsible and the dates of the organisation s involvement. Please limit to 12 entries. Projects which are particularly relevant to the scope of this scheme (as set out in the MoI) should be highlighted. Project Name and Client Name Capital Cost m Status of project Dates of involvement Services Provided/ Company s role D6 Other Relevant Experience Provide any evidence of non-health projects and non-pfi projects that demonstrate the organisation s experience in the last three years relevant to its proposed role in the PFI project. Please limit to 12 entries. Project Name and Client Name Capital Cost m Status of project Dates of involvement Services Provided/ Company s role D7 Provide an analysis of the staff currently employed in PFI work according to seniority as follows: Grade Health PFI Other PFI Totals No % No % No % Partner Director Senior Manager Manager Other (specify) Page 23

26 Section E Declaration On completion of the questionnaire, please read and sign the declaration below. I certify that the information supplied in the questionnaire is accurate to the best of my knowledge and accords with the basic criteria of eligibility as set out in the Memorandum of Information dated [ ]. I also understand it is a criminal offence, punishable by imprisonment, to give or offer any gift or consideration whatsoever as an inducement or reward to any servant of a public body and that such action will empower the NHS Trust to exclude the Consortium or Relevant Organisation from the selected list of bidders. I agree that the NHS Trust may, if it so wishes, make inspections of completed projects, the details of which will be provided if required by the NHS Trust. I hereby declare that I am authorised by the under mentioned Consortium and its member companies to supply the information given above and, at the date of signing, the information given is a true and accurate record. Signed:. Name:. Position: Per pro:. Date:.. The declaration must be signed by an authorised signatory, in his/her own name, and for an on behalf of the Consortium and Relevant Organisations Please return this form with your completed questionnaire. Page 24