Suitability Assessment Questionnaire

for
for	Project Title

Document ID QW4

Office of Government Procurement

Suitability Assessment Works Contractors

Restricted Procedure

Document Reference ID-QW4 v1.0

3 May 2016

© 2016 Office of Government Procurement

Published by: Office of Government Procurement

Department of Public Expenditure & Reform
Government Buildings
Upper Merrion Street
Dublin 2

PROJECT TITLE:CA Entry	DOCUMENT ID. QW4

SUITABILITY ASSESSMENT FOR

USING THE RESTRICTED PROCEDURE

CA Entry: Description of the Specialist Area of Work corresponding subsection 1.9 of QW1

Introduction

The purpose of this suitability assessment questionnaire is to obtain information from specialist applicants to determine their eligibility for the position of specialist subcontractor who will be appointed by the [main] Contractor on a particular project to undertake the specialist works reserved by the Contracting Authority and identified above.

The term Applicant is used in this questionnaire to include an Individual (Sole) Trader, a Legal Partnership, a Consortium or any other type of Joint Venture that constitutes an acceptable entity for the purpose of this project.

The document is in three main parts:

Section 1 gives details of the project and the requirements. The Contracting Authority completes it prior to issuing the questionnaire.

Section 2 is used to collect basic information about the applicant. If the Contracting Authority requires details in addition to the standard details, the Contracting Authority must specify these requirements prior to issuing the questionnaire. The applicant must then use the form to provide the required details.

Section 3 details the criteria that will be used to evaluate the applications. Prior to issuing this questionnaire, the Contracting Authority specifies the criteria that will be used; the applicant must then use the form to provide the required details and to confirm that other required information is appended or will be submitted on request as indicated by completing the checkbox associated with each criterion.

This document is a protected MS Word form (text other than form fields is protected). The applicant should use only those fields marked ‘Applicant Entry’. Other form fields containing project-specific information provided by the Contracting Authority must not be altered. Should an applicant alter any project-specific information in the questionnaire and submit it in its amended state as the applicant’s response, the applicant will be automatically disqualified. The applicant should provide only evidence that is current up to the date of submission indicated below. All signatures must be supplied in hardcopy.

Time and date for return of Questionnaire:

Time and Date:	CA Entry
Return Name and Address (if different from Contracting Authority details in Section 1, below)	CA Entry

Glossary

Acronyms or terms used throughout the questionnaire that are italicised are defined in this glossary.

ARM 4	Agreed Rules of Measurement Revision 4 – These are rules governing the preparation of bills of quantities for building projects. ARM 4 must be amended for use with the Public Works Contracts. The approved amendments are published under ARM 4, 2016, Supplement 1 Issue 2 by the Society of Chartered Surveyors Ireland and the Construction Industry Federation.
BC(A)R	Building Control Regulations 1997 – 2015
CA	Contracting Authority
CESMM 3	Civil Engineering Standard Method of Measurement Revision 3 – These are rules published by the Institute of Civil Engineers governing the preparation of bills of quantities for civil engineering projects. CESMM 3 must be amended for use with the Public Works Contracts. The approved amendments are published under Section 5.2 of guidance note GN 1.5.3 under the CWMF
Consortium	An association or combination of businesses or individuals who combine with the purpose of delivering a single objective. They may be established on a formal or informal basis. Where established on an informal basis, particular arrangements will have to be put in place in order for a contracting authority to be satisfied as to the capacity of such a consortium to perform a contract.
Construction Regulations	Safety, Health and Welfare at Work (Construction) Regulations 2013 and any amendments thereto.
CPV Code	Common Procurement Vocabulary is a single classification system for public procurement aimed at standardising the references used by contracting authorities and entities to describe the subject of procurement contracts.
CRO	Companies Registration Office
CWMF	The Capital Works Management Framework is mandated by Circular for public sector construction procurement and consists of a suite of best practice guidance, standard contracts and generic template documents available for download at http://constructionprocurement.gov.ie/
ESPD	European Single Procurement Document. Where the EU directives apply to the procurement, Contracting Authorities are obliged to accept a completed and signed ESPD from applicants that is submitted in accordance with EU Regulation 2016/7 declaring that the applicant meets the criteria and standards set out as applying to the procurement for which this QW4 has been prepared.
FTS	Form of Tender and Schedule – a series which includes a dedicated form for each of the public works contracts and standard conditions of engagement is published under the Capital Works Management Framework.
Joint Venture	A joint venture is a contractual business undertaking involving two or more parties.
OJEU	Official Journal of the European Union
Partnership	A business that has two or more owners who are individually liable for the entity’s actions. There are different types of partnerships which range from unlimited liability of the individual partners to limited liability of the partners and/or the partnership.
PSCS	Project Supervisor Construction Stage appointed in accordance with the Construction Regulations
PSDP	Project Supervisor Design Process appointed in accordance with the Construction Regulations
PW-CF1	Public Works Contract for Building Works designed by the Employer
PW-CF2	Public Works Contract for Building Works designed by the Contractor
PW-CF3	Public Works Contract for Civil Engineering Works designed by the Employer
PW-CF4	Public Works Contract for Civil Engineering Works designed by the Contractor
PW-CF5	Public Works Contract for Minor Building and Civil Engineering Works designed by the Employer
PW-CF6	Short Public Works Contract
PW-CF7	Investigation Contract
PW-CF8	Short Investigation Contract
PW-CF9	Framework Agreement for Construction Work
PW-CF10	Public Works Contract for Early Collaboration
PW-CF11	Term Maintenance and Refurbishment Contract
QW1	Suitability Assessment Questionnaire for works contractor using the restricted procedure.
QW2	Suitability Assessment Questionnaire for works contractor using the open procedure.
QW3	Suitability Assessment Questionnaire for works specialist using the open or restricted procedure.
QW4	Suitability Assessment Questionnaire for Reserved Specialists using the restricted procedure.
QC1	Suitability Assessment Questionnaire for service provider using the restricted procedure.
QC2	Suitability Assessment Questionnaire for service provider using the open procedure.
Reserved Specialist	The term given to one of the two categories of named specialists [the other being novated specialists] that are to be appointed by the [main] Contractor under public works contracts Pw-CF1, PW-CF3 or PW-CF5. The tender competition for reserved specialists is administered by the Contracting Authority and the successful tenderer for the reserved specialist works is identified by the Contracting Authority and named in the Schedule, part 3 of the public works contract (main contract). Upon award of the [main] contract, the Contractor appoints the named specialist in accordance with the Contract.

SECTION 1: PROJECT PARTICULARS

1.1 Project Information

Project Title:	CA Entry
Approximate size and general description of the works that are the subject of the main contract:	CA Entry: Give a brief description and scope of the project.
Approximate size and general description of the reserved specialist works:	CA Entry: Give a brief description and scope of the Specialist works element of the project.
Main CPV Code:	CA Entry: State CPV code as in the OJEU Contract Notice/etenders Tender Notice.
Form of sub-contract:	Conditions of sub-contract (NN) published by the Construction Industry Federation
Anticipated start of main contract works (date):	CA Entry
Main contract period (months):	CA Entry: Dates should coincide with the period for construction work stated in the Standard Conditions of Engagement for Service Providers or any extension to that period; it must also comply with the Construction Regulations.
Bill of Quantities Method of Measurement:
Proposed number of reserved specialists to be short-listed and invited to tender:	CA Entry

1.2 Contracting Authority Information

Contracting Authority Name:	CA Entry
Contracting Authority Address:	CA Entry
Contact Name:	CA Entry
Contact Address (if different from Contracting Authority):	CA Entry
Contact Telephone No:	CA Entry
Contact Fax No:	CA Entry
Contact Mobile Phone No:	CA Entry
Contact Email Address:	CA Entry

1.3 Specialist’s Role

The successful reserved will be appointed as a subcontractor by the [main] Contractor prior to the Starting Date for the main contract works. They will undertake the specialist works reserved by the Contracting Authority as defined in the tender documents issued to those who are short-listed and invited to tender for the reserved specialist works.

Project Category

Project categorisation for assessment purposes.

Health and Safety

The specialist appointed by the [main] Contractor to undertake the reserved specialist works as a subcontractor will be required to comply with the Safety, Health and Welfare at Work Act 2005 and any subsequent Safety, Health and Welfare legislation including the requirement to have a Safety Statement. The successful specialist works subcontractor will also be required to comply with the Construction Regulations.

Areas of work involving Particular Risks known to Contracting Authority at issue of questionnaire:
CA Entry: Describe any areas of the works involving particular risks, as defined in the Construction Regulations

Other Works

CA Note: List below other works (known at the time) that are going to be carried out by independent contractors who will be working on the site at the same time as the works are under way

The following works will be undertaken on the site by independent contractors at the same time as the works that are the subject of this procurement.

Description of Other Works
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry

1.7 Approximate value of Main Contract

€ CA Note: Enter Approximate value range for main contract (ex VAT).

Other Named Specialist Works

CA Note: List below other named Specialist works categories that are to be novated to, or appointed by, the Contractor

Other Named Specialist Works Categories (Novated or Reserved)
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry
CA Entry

SECTION 2: APPLICANT DETAILS

CA Note: 2.1, 2.2 and 2.3 are used to collect standard basic information from the applicant. If any additional details relating to the applicant's company structure are required, these should be listed in 2.4 or indicate 'not required'.

The Applicant must complete this section. An ESPD, completed in accordance with EU Regulation 2016/7 will suffice to meet this requirement.

Where an Applicant is a Consortium or Joint Venture, the main applicant’s questionnaire (complete with all common information) should be copied and filled out for each active member of that Consortium or Joint Venture. The questionnaires should then be submitted as a single application.

Main/Lead Applicant

Name of Applicant:	Applicant Entry
Address of Registered Head Office:	Applicant Entry
Address(es) of Other Relevant Office(s):	Applicant Entry or enter 'Not Applicable'
Date Business Commenced Trading:	Applicant Entry
Applicant’s Business Name	Applicant Entry or enter 'Not Applicable'
Applicant’s Business Address	Applicant Entry or enter 'Not Applicable'
Applicant’s Company Registration Number (CRO No. or equivalent)	Applicant Entry or enter 'Not Applicable'
Applicant’s Business Registration Number	Applicant Entry or enter 'Not Applicable'
Applicant’s Tax Reference Number	Applicant Entry
Applicant's Self-assessment tax returns Accounting Period for Revenue (or equivalent in other tax jurisdictions)	Applicant Entry
Business Telephone:	Applicant Entry
Business Fax:	Applicant Entry
Business Email Address:	Applicant Entry

Fill in the details below if the company is a subsidiary, otherwise enter ‘Not Applicable’

Name and address of parent company and interest parent has in applicant company (for example, wholly owned by single parent company):	Applicant Entry or enter 'Not Applicable'
Parent Company Registration No.	Applicant Entry or enter 'Not Applicable'
Parent Company Tax Reference No.	Applicant Entry or enter 'Not Applicable'

Fill in this box if there are other companies in a group that will be involved in the contract.

Name and address of other companies in the group involved in this contract including their CRO No. and Tax Reference No. or equivalent:	Applicant Entry or enter 'Not Applicable'
Applicant Entry or Not Applicable	Applicant Entry or enter 'Not Applicable'
Applicant Entry or Not Applicable	Applicant Entry or enter 'Not Applicable'
Applicant Entry or Not Applicable	Applicant Entry or enter 'Not Applicable'

Applicant’s Authorised Representative

There is no need to enter address, telephone, fax and email if identical to company details in 2.1.

Name of Authorised Representative:	Applicant Entry
Representative’s Address:	Applicant Entry or enter 'Not Applicable'
Representative’s Telephone:	Applicant Entry or enter 'Not Applicable'
Representative’s Fax:	Applicant Entry or enter 'Not Applicable'
Representative’s Email Address:	Applicant Entry or enter 'Not Applicable'

Nature of Applicant

Nature of Applicant (for example, sole trader, company, Joint Venture, Partnership):	Applicant Entry

Complete the relevant box below.

Company
Company Type	Applicant Entry or enter 'Not Applicable'
Year established:	Applicant Entry or enter 'Not Applicable'
Number of years actively trading under present name:	Applicant Entry or enter 'Not Applicable'
Name of Chairman/CEO/MD:	Applicant Entry or enter 'Not Applicable'
Interest of Chairman/CEO/MD in other companies:	Applicant Entry or enter 'Not Applicable'
Changes to group structures or mergers over the past 5 years:	Applicant Entry or enter 'Not Applicable'

This box to be filled in only by the Lead of a Legal Partnership, a Consortium or any type of Joint Venture.

Legal Partnership, Consortium or a Joint Venture company
Names of all members in Partnership, Consortium or Joint Venture company:	1. Applicant Entry or enter 'Not Applicable'
2. Applicant Entry or enter 'Not Applicable'
3. Applicant Entry or enter 'Not Applicable'
4. Applicant Entry or enter 'Not Applicable'
Was Partnership, Consortium or a Joint Venture company formed for this project?	Applicant Entry: Yes/No/Not Applicable
If you answered ‘No’ above, state number of years actively trading under present name:	Applicant Entry or enter 'Not Applicable'
Method of financing Partnership, Consortium or Joint Venture company:	Applicant Entry or enter 'Not Applicable'

Additional Applicant Details

Additional details of the Applicant’s business are requested below if required

CA Note: if not in use enter 'Not Applicable' in each column

CA Entry (optional) CA Entry (optional) CA Entry (optional)	Applicant entry Applicant entry Applicant entry

SECTION 3: ASSESSMENT CRITERIA

The criteria that will be used in evaluating submissions are set out in this section.

Some of these are simple Pass/Fail criteria – these are requirements that must be met in full, and, if passed, have no further role in calculating the applicant’s overall score. If failed, the applicant is eliminated from the competition.

Others have minimum Pass/Fail requirements, beyond which they are qualitatively evaluated; each such criterion is given an allocation of marks to be used to calculate the applicant’s overall score, as indicated below.

All Health and Safety criteria are simple Pass/Fail criteria only; reference supplements 3.4.1 and 3.4.2.

The Applicant must complete this section by attaching (where requested) the required information numbered according to the criteria here and then ticking the relevant box to confirm the attachment.

The matrices at Tables 1, 2 and 3 indicate which criteria apply to the application. Where the matrix indicates that the criterion is applicable, the Applicant should have regard to the response required and the evaluation to be applied by the Contracting Authority to each criterion.

For each criterion marked as Response: Evidence Required, applicants must provide the information specified in the corresponding section of the form no later than the date set for the return of the form, and, where appropriate, confirm in the box provided that it is included with the completed questionnaire. Failure to do so could invalidate the submission.

For each criterion marked as Response: Declaration Required, applicants must initially provide the Appendices referenced under each criterion no later than the date set for the return of the forms, and, where appropriate, confirm in the box provided that it is included with the completed Questionnaire. Failure to do so could invalidate the submission. Other supporting documentation should be provided promptly upon request from the Contracting Authority.

Applicants may also satisfy this requirement by submitting an ESPD completed in accordance with EU Regulation 2016/7. By completing Part IV (α) of the ESPD titled: Global Indication for all Selection Criteria, applicants will be taken to declare that they meet the standards set for all criteria where where the response is Declaration Required. Supporting documentation should be provided promptly upon request from the Contracting Authority.

For criteria marked as Response: Submit on Request, applicants should provide the information if requested (that is if the Contracting Authority does not already have such up-to-date material on file) before the commencement of the evaluation exercise as notified by the Contracting Authority.

For criteria marked as Response: Not Required, applicants should not provide the information.

If the Applicant is submitting multiple forms that require common information for any one project, it may be possible to submit such information just once, if clearance (in writing, for example, letter or email) to do so is obtained in advance from the Contracting Authority.

After the closing date, applicants may be asked to clarify aspects of their application, by written submission, by interview or by both, for any of the suitability assessment criteria specified as Evidence Required or Declaration Required. If such clarification is requested, any additional material supplied must be strictly to supplement material already provided in the original submission.

Applications by Consortium, Joint Venture or Partnership: Where an Applicant is a Consortium, Joint Venture or Partnership, the questionnaire is filled out for each member of that Consortium, Joint Venture or Partnership and all the completed questionnaires are submitted as a single application. These questionnaires are then evaluated and marked as a single application. All submissions are taken into account and evaluated initially on a pass/fail basis as if the information was submitted in one single questionnaire. Those Applicants that pass the initial evaluation stage will have their questionnaires qualitatively assessed, marked as a single application and may be successful in being short-listed.

For those who apply as a Consortium, are subsequently invited to tender as a Consortium, and the Consortium members have not set up together as a company (to be the legal entity which enters into the contract), one member of the Consortium must act as the lead member in submitting the tender. The part of the contract that each member of the Consortium will perform should be identified as part of the tender submission. If a Consortium tender is successful, and the members do not wish to register as a company, a contract will be awarded to the lead member. Only the lead member will be paid for the performance of the contract. In such a circumstance the Consortium must provide details of the formal arrangements in place between the members prior to the award of the contract.

Table 1: contracting Authority’s Assessment Scheme and Applicant’s Summary

CA Note: in the table below confirm which of the criteria are applicable by choosing from the options available under the column titled 'Applicable'. State the manner in which the criterion should be answered in the column titled 'Response'. Where the criterion is not applicable select 'Not Required' under the Response column. Select the type of evaluation from the column titled 'Evaluation' or N/A where the criterion is not applicable.

Applicants: Tables 1, 2 and 3 below summarise the assessment criteria that will apply to your application, what you are required to submit in response to each criterion and how the criteria will be assessed – in a restricted procedure the Contracting Authority has the discretion to decide that certain criteria will be assessed on a pass/fail or pass/fail plus qualitative basis (Qualitative). Where a criterion requires documentary evidence to be submitted, the relevant criterion will set out the extent of documentation and how it should be submitted. Where the Contracting Authority has noted that they will accept a declaration in relation to the criterion, they will also note the documentary evidence required to satisfy the criterion. Following a request from the Contracting Authority, this evidence must be submitted promptly otherwise the Applicant risks elimination.

No.	Requirement/Criterion	Applicable	Response	Evaluation
3.1	TENDERER’S PERSONAL SITUATION
3.2	PROFESSIONAL OR TRADE REGISTER
3.3	FINANCIAL & ECONOMIC STANDING
3.3a	Annual Turnover
3.3b	Balance sheet or Extracts from a Balance Sheet
3.3c	Banker’s Letter
3.3d	Other Financial/Economic Information/References
3.3e	Professional Indemnity Insurance
3.3f	Public Liability Insurance
3.3g	Employer’s Liability Insurance
3.3h	Performance Bond
3.4	TECHNICAL CAPABILITY
3.4a	Educational and Professional Qualifications (Managerial)
3.4b	Educational and Professional Qualifications (Personnel)
3.4c	List Works carried out over the Past Years
3.4d	List Technicians or Technical Bodies involved especially those responsible for Quality Control and those whom the contractor can call on in order to carry out work
3.4e	A statement of the Average Annual Numbers of Persons Employed by the Contractor and those in a Managerial Position over the Past 3 Years
3.4f	A statement of the Technical Equipment Available

TABLE 2: Supplement 3.4.1 – Specialist (Health and Safety)

Supplement 3.4.1 (summarised below) must always be filled in by the Applicant.

No.	Requirement/Criterion	Applicable	Response	Evaluation
3.4.1	TECHNICAL CAPABILITY (Health and Safety competence of Works Specialist).
3.4.1a	Educational and Professional Qualifications (Managerial)
3.4.1b	Educational and Professional Qualifications (Personnel)
3.4.1c	List Projects of a Similar Nature Provided over the Past 5/7 Years
3.4.1d	Measures for Ensuring Quality
3.4.1e	Average Annual Manpower over the Past 3 Years

TABLE 3: Supplement 3.4.2 –

Supplement 3.4.2 (summarised below) must be also filled in by the Applicant where there is an element of design in the specialist area of work and identified in Section 1.3.

No.	Requirement/Criterion	Applicable	Response	Evaluation
3.4.2	TECHNICAL CAPABILITY (Health and Safety competence of Specialist with design).
3.4.2a	Educational and Professional Qualifications (Managerial)
3.4.2b	Educational and Professional Qualifications (Personnel)
3.4.2c	List Projects of a Similar Nature Provided over the Past 3/5 Years
3.4.2d	Measures for Ensuring Quality
3.4.2e	Average Annual Manpower over the Past 3 Years

TABLE 4: QUALITATIVE ASSESSMENT – MARKING

CA Note: If Qualitative Assessment is to be used and markings have been decided enter the appropriate marking in the appropriate column. If Qualitative Assessment is not to be used enter Not Applicable.

The Contracting Authority’s Qualitative Assessment scheme is outlined in the table below if available.

NOTE: Markings for Qualitative Assessment criteria may not have been decided at the time of issue of this Questionnaire; they will be available before the latest date for receipt of submissions.

Markings are only to be used (where required) in relation to the following criteria in the main area of the questionnaire.

1	2	3
No.	Requirement/Criterion	Marking
3.3	FINANCIAL & ECONOMIC STANDING
3.3b	Balance Sheet or Extracts from a Balance Sheet	CA Entry
3.3d	Other Financial/Economic Information/References	CA Entry
3.4	TECHNICAL CAPABILITY
3.4a	Qualifications (Managerial)	CA Entry
3.4b	Qualifications (Personnel)	CA Entry
3.4c	List of Works carried out over the Past 5/7 Years.	CA Entry
3.4e	A statement of the Average Annual Numbers of Persons Employed by the Contractor and/or Service Provider and those in a Managerial Position over the Past 3 Years	CA Entry
Total	CA Entry

Whilst the criteria that follow are taken from Directive 2004/18/EC and SI Number 329 of 2006 they can equally be applied to procurements below the EU thresholds.

3.1 EVIDENCE OF APPLICANT’S PERSONAL SITUATION

Criterion Applicable: Response: Type of Evaluation:

If any one of the grounds specified in Article 54 of Directive 2004/17/EC (and Regulation 56 of S1 No 50 of 2007) or Articles 45 of Directive 2004/18/EC (and Regulation 53 of SI No 329 of 2006) apply to the applicant, the applicant will be excluded from this competition (subject to footnote).

The evidence required to confirm that none of these grounds apply is the declaration form at APPENDIX A (or a certified copy thereof). It must be accompanied by the confirmation at Appendix A1, signed by the applicant or on behalf of the applicant.

Prior to the award of any contract, the successful tenderer will be required to produce a current tax clearance certificate or demonstrate a satisfactory level of subcontractor tax compliance from the Revenue Commissioners.

Applicant Entry: Check the corresponding box to confirm that the evidence required:
(a) is attached with your response under Criterion 3.1 (if Response is EVIDENCE REQUIRED), or
(b) will be submitted at the appropriate time if requested (if Response is SUBMIT ON REQUEST).

3.2 ENROLMENT ON PROFESSIONAL OR TRADE REGISTER

Criterion Applicable: Response: Type of Evaluation:

Provide evidence of enrolment on a relevant Professional or Trade Register (e.g. company registration number) in accordance with Article 54 of Directive 2004/17/EC (and Regulation 56 of SI No 50 of 2007) and Article 46 of 2004/18/EC (and Regulation 54 is SI No 329 of 2006) and supplementary requirements (if any) as identified by the Contracting Authority below.

CA Entry: Specify any other requirements here.

Applicant Entry: Check the corresponding box to confirm that the information requested is:
(a) attached with your response under Criterion 3.2 (if Response is EVIDENCE REQUIRED), or
(b) will be submitted at the appropriate time if requested (if Response is SUBMIT ON REQUEST).

3.3 EVIDENCE OF ECONOMIC AND FINANCIAL STANDING CRITERIA [ARTICLE 54 OF DIRECTIVE 2004/17/EC (and Regulation 56 of SI No. 50 of 2007) OR ARTICLE 47 OF DIRECTIVE 2004/18/EC (and Regulation 55 of SI No. 329 of 2006)]

Information in 3.3 must be provided by the applicant, and by the applicant’s parent company where the applicant is a subsidiary and is relying on it’s parent company to meet the requirements of criterion 3.3.

3.3a EVIDENCE OF TURNOVER

CA Note: You may change the requirement for the response to this criterion (in text fields below) and create an equivalent requirement in its place as long as it is appropriate and relevant to the criterion. You may not change the objective or title.

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion is certified statements of yearly turnover for the 3 most recently completed financial years in accordance with the specific requirements set out below. If, for a reason deemed valid by the Contracting Authority, the evidence sought cannot be provided then alternative evidence which is considered appropriate by the Contracting Authority may be provided.

Turnover Requirement

Area of Business/Work:	Yearly Turnover arising from the area of work specified:
CA Note: State the Reserved Specialists works category here	€ CA Entry

CA Entry: Specify any other requirements here.

CA Note: If stating a minimum yearly turnover threshold, take care the standard is not set at a level that discriminates against otherwise suitable applicants.

The aggregated turnover for all members of a consortium or joint venture must meet the turnover requirement set above. If only one member has the skills, resources and experience for the work, that member must have an average turnover that demonstrates financial capacity for the work as set out below.

CA Entry: In relation to consortia or similar, a percentage of the overall turnover requirement appropriate to each of the roles deemed critical may be specified here. Where used, the CA should set percentages that are proportionate to those roles.

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3a (if response is EVIDENCE REQUIRED)

3.3b BALANCE SHEET OR EXTRACTS FROM A BALANCE SHEET

CA Note: You may change the requirement for the response to this criterion (in text fields below) and create an equivalent requirement in its place as long as it is appropriate and relevant to the criterion. You may not change the objective or title.

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion should be in accordance with the requirements identified below (or if for any valid reason this evidence cannot be provided then alternative evidence which is considered appropriate by the Contracting Authority may be provided).

CA Entry

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3b (if response is EVIDENCE REQUIRED)

3.3c BANKER’S LETTER

CA Note: You may change the requirement for the response to this criterion (in text fields below) and create an equivalent requirement in its place as long as it is appropriate and relevant to the criterion. You may not change the objective or title. For contract values in excess of €5m Contracting Authorities should consider whether the basic requirements set for the banker's letter should be increased to provide more detailed information. If so the drop down menu below should be changed to say (in the format set out at Appendix J) and the text in the subsequent form field deleted entirely.

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion is a letter from the applicant’s current principal banker dated within the past 3 months stating that, to the best of it’s knowledge, this is the applicant’s principal account and it is currently in good standing.

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3c (if response is EVIDENCE REQUIRED)

3.3d OTHER FINANCIAL/ECONOMIC INFORMATION/ REFERENCES

CA Note:You may create a financial criterion in the blank field below. The title should be changed to reflect the requirement(s). The criterion should be appropriate and relevant so that the evidence sought can demonstrate economic and financial standing.

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion should be in accordance with the requirements identified below (or if for any valid reason this evidence cannot be provided then alternative evidence which is considered appropriate by the Contracting Authority may be provided).

CA Entry

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3d (if response is EVIDENCE REQUIRED)

3.3e PROFESSIONAL INDEMNITY INSURANCE

CA Note: You may change the requirement for the response to this criterion (in text fields below) and create an equivalent requirement in its place as long as it is appropriate and relevant to the criterion. You may not change the objective or title.

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion may be either;

(i) evidence from an insurance provider authorised to issue non-life insurance or from an authorised insurance advisor confirming that Professional Indemnity Insurance (PII) meeting the requirements set out below is in place, or

(ii) the Letter of Undertaking at Appendix K which may be provided where the applicant does not have PII or does not have PII at the levels required below.

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Prior to appointment (where there is a requirement for PII), the successful tenderer will be required to produce evidence in the form set out a (i) above and that it will be maintained for years after completion of the construction works. (If for any valid reason this evidence cannot be provided then alternative evidence that is considered appropriate by the Contracting Authority may be provided).

The level of cover as stated here:

Minimum level of Professional Indemnity Insurance required for specialist works subcontractor	€ CA Entry

CA Note: State the minimum cover proportionate to the size of the project (default level is €1.5m)

The excess as stated here:

Maximum permissible excess on Professional Indemnity Insurance in any one claim below which the specialist works subcontractor will bear the cost:	€ CA Entry

CA Note: State the maximum permissible excess for which the Specialist Works Subcontractor will bear cost of claims.

Cover provided on an basis;

CA Note: If cover on an ‘each and every claim' basis is required, it should be ascertained in advance of publication of this SAQ whether such cover is readily available for the specialist works category concerned.

Cover is provided for legal defence costs in excess of the minimum level of cover

The conditions provide for claims for breach of professional duty or civil liability as well as negligence;

Cover extends to include claims arising out of the sub-contracting of professional services by the applicant;

Cover is provided in respect of Joint & Several liability where the Applicant is operating in a Joint Venture or a Consortium;

The level of excess is capped at €150,000 in any one year regardless of the number of claims;

The jurisdiction in which claims can be lodged and settled is IRELAND.

CA Entry: Specify any other requirements here.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3e (if response is EVIDENCE REQUIRED)

3.3f PUBLIC LIABILITY INSURANCE

Criterion Applicable: Response: Type of Evaluation:

Before appointment, the applicant will be required to produce evidence from an insurance provider authorised to issue non-life insurance or from an authorised insurance advisor confirming that the applicant has current public liability insurance cover complying with the requirement(s) set out below.

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Minimum level of Public Liability Insurance required in respect of any one accident:	€ CA Entry
Maximum level of excess for property only* for any one incident below which the specialist works subcontractor will bear the cost:	€ 10,000

*No excess is permitted in respect of death, injury or illness.

CA Note: Specify any other requirements here.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3f (if response is EVIDENCE REQUIRED)

3.3g EMPLOYER’S LIABILITY INSURANCE

Criterion Applicable: Response: Type of Evaluation:

Before appointment, the applicant will be required to produce evidence from an insurance provider authorised to issue non-life insurance or from an authorised insurance advisor confirming that the applicant has current Employer’s Liability insurance cover complying with the requirement(s) set out below.

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

Minimum level of Employer’s Liability Insurance required in respect of any one accident:	€ CA Entry

CA Note: Specify any other requirements here.

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3g (if response is EVIDENCE REQUIRED)

3.3h PERFORMANCE BOND

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion is the Letter of Undertaking at Appendix I provided by a surety authorised to do guarantee business in Ireland stating that they are in a position to provide a performance bond to meet the requirements listed below.

Where the response above is ‘Declaration Required’ the declaration at Appendix D should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

If this criterion applies, upon appointment by the main contractor, the Specialist Works Subcontractor is required to give the main contractor a Performance Bond complying with Model Form MF 1.19 and the particular requirements set out below.

The amount of the Performance Bond required (expressed as a percentage of the eventual Sub-Contract Sum):	CA Entry %
Period after Substantial Completion [of the main contract] where the surety is released of their total liability:	CA EntryMonths

CA Entry: Specify the Performance Bond requirements in the box above followed by supplementary requirements here (if any).

Applicant Entry: Check the appropriate box to confirm that:
Appendix D (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.3h (if response is EVIDENCE REQUIRED)

3.4 EVIDENCE OF TECHNICAL CAPABILITY CRITERIA [ARTICLE 54 OF DIRECTIVE 2004/17/EC (AND REGULATION 56 OF SI No. 50 OF 2007) OR ARTICLE 48 OF DIRECTIVE 2004/18/EC (AND REGULATIONS 57 OF SI No. 329 OF 2006)

In the context of technical capability the applicant should carefully consider the responses in this subsection in relation to the role of Contractor that is required for the project as outlined in Section 1.

In relation to Health and Safety supplement 3.4.1(HS) for Specialist Works must also be completed and where appropriate 3.4.2(HS) for Specialist with Design.

CA Note: Ensure that the requirements set under 'Applicable' and 'Response' is consistent in supplement 3.4.1 and 3.4.2 (where applicable).

3.4a EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS (Management)

Criterion Applicable: Response: Type of Evaluation:

The evidence required for assessment purposes under this criterion is the educational and professional qualifications (with dates obtained) and experience (on similar projects) of their managerial staff, and include the curricula vitae of the managerial staff and the organization structure in accordance with the requirements (if any) identified below.

If Health and Safety evidence of the specialist’s management staff’s educational and professional qualifications and experience in relation to Works or Design is included here it should then be cross-referenced in Supplements 3.4.1a (HS) and 3.4.2a (HS) where appropriate: such evidence will always be assessed under these sections.

CA Entry: List here supplementary requirements (if any) in relation to this criterion.

Applicant Entry: Check the appropriate box to confirm that the information requested
is attached with your response under Criterion 3.4a (if response is EVIDENCE REQUIRED), or
will be submitted at the appropriate time if requested (if response is SUBMIT ON REQUEST)

3.4b EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS (Personnel)

Criterion Applicable: Response: Type of Evaluation:

The evidence required for assessment purposes under this criterion is the educational and professional qualifications (with the dates obtained) of the Applicant’s personnel proposed for the project, including the curricula vitae of the personnel in compliance with the specific requirements (if any) identified below.

If Health and Safety evidence of the educational and professional qualifications and experience of the specialist’s personnel for the project on projects of a similar size and complexity in relation to Works or Design is included here it should then be cross-referenced in Supplements 3.4.1b (HS) and 3.4.2b (HS) as appropriate: such evidence will be assessed under those sections.

CA Entry: List here supplementary requirements (if any) in relation to this criterion.

Applicant Entry: Check the appropriate box to confirm that the information requested
is attached with your response under Criterion 3.4b (if response is EVIDENCE REQUIRED), or
will be submitted at the appropriate time if requested (if response is SUBMIT ON REQUEST)

3.4c LIST OF WORKS CARRIED OUT OVER THE PAST YEARS

Criterion Applicable: Response: Type of Evaluation:

A Contracting Authority may only require an Applicant to submit a list of works projects provided over a maximum period of 5 years. However a Contracting Authority may take into account works delivered over a longer period if appropriate. The period specified in the sub-criterion title above is the period within which the Applicant may submit evidence of the works contracts it has delivered, it is not mandatory that projects be evidenced for the whole period. If a firm cannot provide evidence for the entire period (e.g. a firm has not been trading for the whole period) this will not be used as a reason to reject its application.

The evidence required for assessment purposes is details of works that the Applicant has completed over the period stated above that are similar in nature and complexity to the specialist element of the Works required for this project. The evidence must be provided in the format specified below. (Note that the request is not necessarily for projects that are identical to the project that is the subject of this Questionnaire).

Where a list of projects is sought it should be provided in the standard form at Appendix B1 in accordance with particular requirements set out below. The references (i.e. Certificates of Satisfactory Execution) required in relation to these projects should be submitted using the standard form provided at Appendix B2. Supplementary requirements (if any) will be stated by the Contracting Authority below.

If Health and Safety evidence in relation to Works is included here it should then be cross-referenced in Supplement 3.4.1c (HS); such evidence will be assessed under that section. Health and Safety evidence in relation to Design should NOT be supplied here – it must be dealt with in Supplement 3.4.2c (HS).

CA Entry: List here supplementary requirements (if any) in relation to this criterion.

Applicant Entry: Check the appropriate box to confirm that:
Appendix B1, B2 and any additional evidence set out by the Contracting Authority are attached with your response (if response is EVIDENCE REQUIRED), or
The evidence required will be submitted at the appropriate time if requested (if response is SUBMIT ON REQUEST)

3.4d LIST OF TECHNICIANS OR TECHNICAL BODIES INVOLVED ESPECIALLY THOSE RESPONSIBLE FOR QUALITY CONTROL AND THOSE WHOM THE SPECIALIST WORKS SUBCONTRACTOR CAN CALL ON IN ORDER TO CARRY OUT WORK

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion is a list of the relevant technicians or technical bodies upon whom the Applicant can call on in order to carry out the work or whom the Applicant can use in regard to quality control, particularly in the context of ensuring quality both in the administration of a project and the delivery of a high quality end-product.

Where the response above is ‘Declaration Required’ the declaration at Appendix E should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

If Health and Safety evidence is included here it should then be cross-referenced in Supplements 3.4.1d (HS) and 3.4.2d (HS) as appropriate: such evidence will be assessed under the relevant section.

CA Entry: List here supplementary requirements (if any) in relation to this criterion.

Applicant Entry: Check the appropriate box to confirm that:
Appendix E (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.4d (if response is EVIDENCE REQUIRED)

3.4e A STATEMENT OF THE AVERAGE ANNUAL NUMBERS OF PERSONS EMPLOYED BY THE SPECIALIST WORKS SUBCONTRACTOR AND THOSE IN A MANAGERIAL POSITION OVER THE PAST 3 YEARS

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion is details of the average annual manpower and managerial staff over the past three years in accordance with the requirements (if any) identified below.

If Health and Safety evidence in relation to the Works or Design over the past 3 years is included here it should then be cross-referenced in Supplements 3.4.1e (HS) and 3.4.2e (HS) as appropriate: such evidence will be assessed under the relevant section.

CA Entry: List here supplementary requirements (if any) in relation to this criterion.

Applicant Entry: Check the appropriate box to confirm that:
is attached with your response under Criterion 3.4e (if response is EVIDENCE REQUIRED), or
will be submitted at the appropriate time if requested (if response is SUBMIT ON REQUEST)

3.4f A STATEMENT OF THE TECHNICAL EQUIPMENT AVAILABLE

Criterion Applicable: Response: Type of Evaluation:

The evidence required to pass this criterion is details of the technical equipment available to the Applicant to carry out the project and the requirements (if any) listed below.

Where the response above is ‘Declaration Required’ the declaration at Appendix F should be provided initially. Evidence will be sought from successful applicants prior to shortlisting.

CA Entry: List here supplementary requirements (if any) in relation to this criterion.

Applicant Entry: Check the appropriate box to confirm that:
Appendix F (or a completed ESPD) is attached with your response (if response is DECLARATION REQUIRED), or
The evidence requested is attached with your response under Criterion 3.4f (if response is EVIDENCE REQUIRED)

On behalf of the Applicant, I certify that the Applicant is not guilty of misrepresentation in supplying or failing to supply the information requested in response to the questionnaire above, including: CA Note: Amend the declaration and evidence requirements below to match the requirements in the completed QW4. a) The following completed declarations attached: Self Declarations at Appendices A1, D, E & F or ESPD (where applicable) Template evidence documents at Appendices B1 & B2 Third Party Certification in the form of declarations at Appendices A, I, J & K b) CA Entry: list here any other documents that are required c) Health and Safety Supplement 3.4.1 with declarations: a. Self Declarations at Appendices C1, C3, E & G or ESPD (where applicable) b. Template evidence documents at Appendices B1 & B2 c. Third Party Certification to OHSAS 18001, SafeTCert or equivalent d) Health and Safety Supplement 3.4.2 with declarations: a. Self Declarations at Appendices C1, C5, E & H or ESPD (where applicable) b. Template evidence documents at Appendices B1 & B2 c. Third Party Certification to OHSAS 18001, SafeTCert or equivalent so as to demonstrate/confirm compliance with the relevant criteria. Signed: _________________________________ Date: _________________ Name: Applicant Entry [block letters] Title: Applicant Entry [block letters] For and on behalf of the Applicant (signature must be that of a Director/Principal with date in hardcopy)

The Contracting Authority must select the category of project, in general:

• Type 1 project has a value < €500,000;

• Type 2 project has a value €500,000 to €5,000,000; or

• Type 3 project has a value > €5,000,000.

However considerations in relation to the H&S risk must also be taken into account in deciding on the project type. If there is a high H&S risk the category may need to be higher than that indicated by the project value above. The category of project chosen then governs decisions to be made about criteria and requirements in section 3 of the form.

State the full name of a Company as it is registered with the CRO or equivalent in country of establishment.

State the full name of a Business as registered with the CRO or equivalent in country of establishment where the applicant is an individual or partnership (whether composed of individuals or bodies corporate or any combination of both) or any body corporate carries on business under a name other than their own true names.

The numbers in this column reference the subsection numbers of the criteria in this questionnaire.

The numbers in this column reference the subsection numbers of the criteria in this questionnaire.

For the purposes of this competition the term applicant includes all members of a Consortium or Joint Venture or their parent companies.

Before an applicant, in relation to a breach under 2(a)-(d) in form at Appendix A, is excluded the applicant may make a case and provide supporting evidence as to why it should not to be excluded. The Contracting Authority must consider this evidence before making a decision whether to exclude or include the applicant.

In Ireland and the UK this must always be witnessed in the presence of a Commissioner for Oaths. In other jurisdictions where there is no provision for a declaration on oath one of the alternative arrangements appropriate to the jurisdiction can be provided.

The Contracting Authority reserves the right to inspect the original at any time if considered necessary.

As a result of the introduction of the new electronic Relevant Contracts tax (e-RCT) system by the Revenue Commissioners in January 2012 the C2 certificate is no longer in use by subcontractors. This change will require to be reflected in the Department of Finance procedures for tax clearance in relation to public sector contracts. Accordingly Circular 43/2006 is being revised and a replacement will issue shortly. In the interim, more details are available at http://www.revenue.ie/en/tax/rct/subcontractor.html Note that the changes relate to use of the C2 only.

Authorised means that the insurance provider meets the requirements set down in SI 359 of 1994 European Communities (Non-Life Insurance) Framework Regulations, 1994.

Where the contract is to be executed under hand then a period of 6 years should be sought for the Professional Indemnity Insurance, where the contract is to be executed under seal then a period of 12 years should be sought.

If no Minimum is specified, €1.5m (One million and five hundred thousand Euros) applies.

If no Maximum is specified, it shall read as €45,000 (Forty five thousand Euros) or 1.5% of turnover whichever is greater.

Where the Applicant is a multi-national organisation and its level of excess for insurance purposes is based upon the turnover of the multi-national organisation, a higher level of excess may be accepted providing a parent company guarantee is provided to cover the level of excess.

Authorised means that the insurance provider meets the requirements set down in SI 359 of 1994 European Communities (Non-Life Insurance) Framework Regulations, 1994.

If no value is entered it shall read as €6,500,000 (six million five hundred thousand euro)

Authorised means that the insurance provider meets the requirements set down in SI 359 of 1994 European Communities (Non-Life Insurance) Framework Regulations, 1994.

If no value entered it shall read €13,000,000 (Thirteen million Euro) – No excess is permitted on Employer’s Liability Insurance

See the Authorised Bonding Business guidance on the Construction Procurement Reform website http://constructionprocurement.gov.ie/authorised-bonding-businesses/

Model Form MF 1.19 as published on the Construction Procurement Reform website http://constructionprocurement.gov.ie

If no value entered it shall read 10% of the eventual Contract Sum for the Specialist Works Subcontract

If no value entered it shall read 15 months

Article 48.2(b) of Directive 2004/18/EC and Regulation 57 of SI No 329 of 2006