Professional Documents
Culture Documents
Cleaning Services –
Lower Murray Service Region
Contents
1. Instruction........................................................................................................................3
2. Corporate details..............................................................................................................3
3. Executive Summary...........................................................................................................3
4. Declaration.......................................................................................................................4
5. Supplier Code of Conduct Commitment Letter.................................................................5
6. Schedule 1 - Pricing...........................................................................................................7
7. Schedule 2 - Project Management / Delivery...................................................................7
8. Schedule 3 - Capability and Experience............................................................................8
9. Schedule 4 - Commercial compliance.............................................................................11
10. Schedule 5 - Conflict of Interest......................................................................................14
11. Schedule 6 – Social Procurement outcomes...................................................................15
2. Corporate details
TENDERER DETAILS
1. Company Name
7. Phone
8. Email
3. Executive Summary
Provide a brief (less than one page) executive summary providing an overview of the Tender Response, and
your understanding of the project.
2. Part B – Conditions of participation and have read and accept the conditions of the Invitation.
Invitee:
Name:
Position:
Signature of invitee’s:
authorised officer:
Date of execution:
[Note to tenderers: The Victorian State Government's Supplier Code of Conduct is available at the Victorian Government
Purchasing Board website: http://www.procurement.vic.gov.au/Home. Updates and amendments to the Code will also
be made available at this website.
Tenderers are to familiarise themselves with the Supplier Code of Conduct and must include in their tender response a
Commitment Letter substantially in the form provided here, addressed to the contact officer listed at [insert] of the
request for tender]
CN0440
1. I acknowledge that:
a. the Victorian State Government (the State) is committed to ethical, sustainable and
socially responsible procurement;
b. the State has a Supplier Code of Conduct (Code) the Code describes the State's
minimum expectations of the conduct of its suppliers in relation to:
i. integrity;
ii. ethics and conduct;
iii. conflicts of interest;
iv. gifts, benefits and hospitality;
v. corporate governance;
vi. labour and human rights;
vii. health and safety; and
viii. environmental management;
c. the expectations set out in the Code are not intended to reduce, alter or supersede
any other obligations which may be imposed by any applicable contract, law,
regulation or otherwise;
d. to ensure that the Code remains current and relevant, it may be amended or
updated by the State; and
Signature: ………………………………………………..
SUB-CONTRACTOR 1:
Name:
Address:
Services to be provided
2. Detail current work related to the requirements detailed in the Specification. Word limit – [250]
words.
Other:
Provide details
Is there a written Company OHS Policy that has be reviewed in the last 2 years,
that incudes OHS responsibilities for personnel and management of risks??
If yes, provide a copy
If yes, provide a copy of the procedure and a standard incident report form
Has the company ever been convicted of or have court action pending in relation
to an operational health and safety offence?
Have any actions of your company resulted in enforcement or issues raised by any
WorkSafe Victoria, Environment Protection Authority, Energy Safe Victoria or
other relevant inspectorate and/or HSR activity within the past 24 months
including:
• prohibition notices;
• improvement notices;
• written directions;
• provisional improvement notices issued by a HSR;
• activities relating to an incident notified to WorkSafe Victoria under Part 5
of the Occupational Health and Safety Act 2004; or
• any prosecution commenced by WorkSafe Victoria or completed, within the
period
If yes, provide details
Have you made a work cover claim in the last three years
Provide a copy of your work cover insurance certificate of currency and premium
rate and industry classification.
Level of Cover
Level of Cover
1 FINANCIAL HISTORY
1.1 Has the Tenderer, or have any of the Tenderer’s company directors or the Tenderer’s
company secretary, ever
Had any other insolvency or Yes (Please attach all relevant details)
bankruptcy actions commenced
No
against them
Been engaged in the management of Yes (Please attach all relevant details)
a company which has taken or had
No
instigated against it any action
resulting in the winding up of the
company, being placed under official
management or had a receiver and
manager appointed?
1.2 Has there been any significant event, matter or circumstance which has arisen since the
end of the last financial year which may adversely affect the operations of the Tenderer, its
1.3 Is there, or has there been, any merger or acquisition that can be notified, either recent
(within the past 12 months) or which is imminent?
1.4 Have there been any material court proceedings of any kind, actual or threatened, against
the Tenderer, its ultimate Australian parent or associated entities or any director of the
Tenderer, its parent or associated entities within the past 5 years?
1.5 Have there been any de-registration actions against the Tenderer, its ultimate parent or
associated entities within the past 5 years?
1.6 Have there been any actions of insolvency proceedings, actual or threatened (including
voluntary administration, application to wind up, or other) against the Tenderer, its parent
or associated entities within the past 5 years?
Have there been any material breaches of or defaults under any agreement, order or
award binding on the Tenderer, its ultimate parent company or associated entities?
1.7
1.8 Have there been any other factors which could impact on the financial ability of the
Tenderer, its ultimate parent company or associated entities to successfully perform the
Agreement?
1.9 Is the Tenderer 'trading solvent and able to meet its debts as and when they fall due in the
normal course of business'?
1.13. Management
Outline the processes you have in place to handle any future conflict of interest (actual or perceived).
3494 Nangiloc, Carwarp Colignan Area 3579 Kerang, Murrabit Mystic Park et
Cullulleraine, Cardross, Red Cliffs,
3496 3580 Koondrook
Werrimull, Sunny Cliffs
3500 Mildura 3588 Woorinen south
3505 Merbein Yelta Cabarita Area 3594 Nyah
3549 Robinvale and surrounds 3595 Nyah West
3596 Wood Wood, Miralie 3585 Swan Hill Area
6. Does your organisation provide opportunities for Aboriginal ☐ ☐ Instruction: If ‘YES’, explain:
people or use certified Aboriginal businesses
1. Does your organisation have policies and/or procedures
☐ ☐ Instruction: If ‘YES’, list which ones your organisation has in place.
for the following:
2. Equal opportunity and anti-discrimination;
3. Family violence leave;
4. Workers compensation;
5. Long service leave; or
6. Superannuation.
7. Does your organisation have a formal environmental
☐ ☐
management system in place?