Application Form for Expression of Interest for Contracts for Consultancy Services above DKK 900.000 for the Ministry of Foreign Affairs of Denmark - DANIDA

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Dec 13, 2013 (3 years and 7 months ago)

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Application Form for
Expression of
Interest
for
C
ontracts
for
Consultancy

Services
above DKK 900.000
for the Ministry o
f

Foreign Affairs

of Denmark
-

D
ANIDA


Contract Notice:

<S number as stated in the TED>

Contract title:


Danida Framework Agreement for t
echnical assistance to identify,


formulate, appraise and review development programmes and



projects

File number:


104.X.25
-
5

1.

CANDIDATE

This application is submitted by

(add
rows

as required)

:

Candidate

Name(s) of legal entity or entities

Leader
1


Member
s


Other entities


Contact person

of the Candidate
:

Name


Organisation


Address


Telephone


E
-
mail



2.

INSTRUCTIONS TO CANDIDATES

Candidates
expressing
an
interest
in a contract where the Ministry of Foreign Affairs of
Denmark

-

D
ANIDA

is the Co
ntracting Authority must use this application form. The
application must include signed declaration
s

using the format
s

in A
NNEX

A a
n
d

ANNEX

B
from each legal entity m
entioned
in
clause

1 above. The application and declaration(s) must
be submitted using the

cover letter format

in A
NNEX

C
. Any other documentation as
required in the Contract Notice and in this application form must be included. Any additional
documentation not specifically required will not be taken into consideration and should not
be include
d with the

application. The application and the declaration
(s)

as well as the
required documentation must be in English.

Please refer to
this application form as well as
the Contract Notice for the required
documentation and minimum requirements.

A
n a
pplic
ation being submitted by a
consortium

(i.e., either a permanent, legally
established grouping or a grouping, which has been constituted informally for a specific
contract) must follow the instructions applicable to the consortium leader and its members.
No
te that a sub
-
contractor is not considered to be a consortium member
and should not be
included in
this application.

A
n a
pplication must be s
en
t

in paper format
in one original and two copies,
and emailed
in
an electronic version
.

The electronic version o
f the application (PDF file not exceeding 5 Mb) must be

received by

the Contracting Authority at the address stated in the Contract Notice I.1 before the time
limit as stated in the Contract Notice IV.3.4).

The
identical
application in paper format

(
in on
e original and two copies
)

must be sen
t

to
the Contracting Authority at the address stated in the Contract Notice I.1) before the time
limit as stated in the Contract Notice IV.3.4).


References to the Directive in this application form mean the “Directive

2004/18/EC

of the
European Parliament and of the Council of 31 March 2004 on the coordination of procedures
for the award of public works contracts, public supply contracts and public service
contracts”. Please refer to the
Directive

for full text.




1

If this application is bei
ng submitted by an individual legal entity, the name of that legal entity should be entered as
”Leader”, and all other lines should be deleted.


3.

CONDITIONS FOR PARTICIPATION


If the Candidate is a consortium, the consortium as a whole should meet the required
minimum capacities

(a
dd rows as required).

3
.1 Economic and financial standi
ng

(Contract Notice

III.2.2
)

Requirements and possible minimum levels to the economic and financial standing of the
Candidate are specified in the Contract Notice, and are requested in accordance with Article
47 of the Directive.

a)

Annual turnover of the C
andidate

(add rows as required)

DKK

Most recent year


Most recent year
-
1


Most recent year
-
2

Annual Turnover





3
.2 Technical and/or professional ability

(Contract Notice

III.2.3
)

Requirements to the technical and/or professional ability of the Cand
idate are specified in
the Contract Notice

in accordance with Article 48 of the Directive.

If the applicant is a
consortium only
a maximum of
the
20
most relevant services among the consortium
members are to be listed.




a)

List of
similar
services provided

in the last three years

-

Maximum of
20
references

(add
forms
as required)

Ref. No. 1


Legal entity


Project title


Country


Name of Client


Dates (
mm/yy


mm/yy
)


Project value

Mill.
DKK


Share carried out by legal entity %


Consortium members


Desc
ription of

P
roject


Types of services

provided by legal entity




Signed on behalf of the Candidate


Date:


Name:


Signature:

ANNEX A
:


F
ormat of
t
he Declaration referred to in the
A
pplication Form for Expression of Interest


To be submitted on the let
terhead of legal entity
(ies)

concerned
.

(
If the Candidate is a
C
onsortium
the declaration must be submitted
by the
L
eader
and
e
ach
M
ember of the Consortium
)


(
To be addressed to the Ministry of Foreign Affairs of Denmark at the address stated in the
Contr
act Notice I.1)


<Date>


Dear Madam/Sir


<
Contract title
>

In response to your Contract Notice <
S number as stated in the TED
> we, <name(s) of legal
entity or entities> confirm that we intend to submit a tender for the contract for the above if
we are invi
ted to do so.

We hereby declare that we:

1.

Are making this application [on an individual basis/as a member of the consortium led by
<name of the leader/ourselves
;
d
elete as applicable
] for this contract.

2.

Attach
a signed Solemn Declaration
providing sufficie
nt evidence that none of the cases
specified in Article 45, 2, (e) and (f) in the Directive applies to any of the legal entities
making this application
;

3.

Are not in a conflict of interest

or in any other situation
, which would exclude us from
participating

in the contract

(Contract Notice III.2.1);

4.

Will inform
you
immediately if there is any change in the above circumstances at any stage
during the implementation of the contract.

We recognise that you may exclude us from this contract and future contract pr
ocedures if we
are guilty of serious misrepresentation or failing to supply the information that may be
required for this qualitative selection.

Yours sincerely
,



<Signature of authorised representative>

<Name and position of authorised representative>

A
NNEX
B

Format of the
Solemn Declaration

r
eferred to in
the Contract Notice and
the Application Form for Expression of Interest



(
If the Candidate is a Consortium the declaration must be submitted by the Leader
and each Member of the Consortium
)



SOLEMN
DECLARATION


In accordance with
Danish Law’s
Act no. 336 of 13 May 1997

on limitation of debtors
possibilities to participate in public procurements and on change of certain other laws (Making
effective the collection of arrears to the authorities), the au
thorities shall on procurement of
construction and plant works as well as purchases of goods and services demand that any
tenderer simultaneously with submitting its tender make a solemn declaration on the extent of
the tenderer’s unpaid, due debts to the
authorities in the form of taxes, duties and social
security contributions in accordance to Danish law or the law of the country of the tenderer’s
establishment
.


In accordance with the regulations of the abovementioned law the undersigned hereby
solemnly
and under liability to punishment give the below mentioned declaration.


Company name, address, telephone number and registration number:




Information on debts to the authorities (make selection):

1



The company has no unpaid, due debts to the authori
ties
.

2



The company has unpaid, due debts to the authorities but these debts do not exceed
DKK
100.000 (or
an equivalent amount in another currency
).


3




The company has unpaid, due debts to the authorities and these debts exceed
DKK
100.000 (or an
e
quivale
nt amount in another currency).



The following points 4 or 5 and 6 shall only be filled
, if point 3 has been selected.


4






Security has been provided to the collection authority for payment of the part of the debts that exceed
DKK
100.000 (or

an equivalent amount in another currency)
.


Security will be provided to the collection authority for payment of the part of the debts that that
exceed
DKK
100.000 (or an equivalent amount in another currency).


5



An arrangement for payments concerning

unpaid, due debts has been made with the collection
authority, and this arrangement has been kept.


6



Date of establishment of security/arrangement:

Year
:

Month
:

Day
:



Collection authority
:



Name

Address
:

Postal

code
:

City:




Signature
:

Date
:

Company management signature and company stamp:






ANNEX
C

Format of the Cover Letter referred to in the Application Form for Expression of Interest



(
To be submitted on the letterhead of the Candidate

-

T
he

Leader


if the Candidate
is a consortium)

To be addressed to the Ministry of Foreign Affairs of Denmark at the address stated in the
Contract Notice I.1)


<Date>


Dear Madam/Sir


<
Contract title and file number
>

In response to your Contract Notice <
S number as stated in the TED
> we, <name(s) of le
gal
entity or entities>, hereby submits the following documents:

1.

Application Form
;

2.

Declaration
(s)

by <name of legal entity
(ies)
>

with r
equired documentation and certification

(see
ANNEX A

above)
;


I, the undersigned, being the authorised signatory of the
above Candidate (including all
consortium members, in the case of a consortium), hereby declare that we have examined the
Contract Notice for the restricted procedure referred to above.

If we are short
-
listed, we fully intend to submit a tender to provide

the services requested in
the tender dossier.

We are fully aware that, in the case of a consortium, the composition of the consortium cannot
be modified in the course of the tender procedure.

We are also aware that the consortium members would have joint

and several liability towards
the Contracting Authority concerning participation in both the above tender procedure and any
contract awarded to us as a result of it.


Signed on behalf of the Candidate


Date:


Name:


Signature: