ANNEX C
STANDARD SUBMISSION FORM
Provision of Internet, Voip & Mobile Services
F-SE-14-T07	
SUBMITTED BY:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
1. PREAMBLE
Tenderers are requested to include in their tenders all the information and documents requested in the forms attached, in accordance with Annex A – Tender Specifications and the instructions below:
All forms must be dated, signed and stamped by a person authorised to sign on behalf of the tenderer. 
In case of a consortium or group of companies, the tender must be signed by the person appointed in the power of attorney (Form A.4) as authorised to sign the tender on behalf of the consortium or group of companies. 
Each consortium partner must sign a Declaration of Honour with respect to the Exclusion Criteria and Absence of Conflict of Interest (Form B.1). For each identified subcontractor whose intended share of the contract is above 10% of the total contract amount, a signed Declaration of Honour must also be provided.
Each identified subcontractor must complete and sign the Letter of Intent included in Form A.6. 
If the tenderer relies on the economic, financial, technical and professional capacity of the proposed subcontractor(s) to meet the selection criteria, then the subcontractors shall also complete the forms included under Sections C and D. In any other case, the forms included under Sections C and D shall only be completed by the tenderer or by the partners in case of consortium or group of companies. 
In addition to the forms requested in this Annex C, tenderers must submit their technical proposal in a separate envelope clearly marked as “Technical Offer”. Please note that there is no specific template to submit the technical proposal. However, it should be drawn up following the instructions given in Annex A –Tender Specifications and covering all requirements of Annex A.1 Technical Specifications. 

Tenderers’ financial offer shall be prepared in accordance with Form F.1 and shall be submitted in a separate sealed envelope clearly stating “Financial Offer”.
2. CHOICE OF LOT(S) 
Please indicate for which lot(s) you are submitting a tender.
	Lot No	Title	Choice(s)
1	Internet services		
2	VoIP telephony		
3	Mobile telephony		
 (Please tick with an X where appropriate)
SECTION A – TENDERERS IDENTIFICATION

FORM A.1 – ADMINISTRATIVE DETAILS	
1. TENDERER’S DETAILS	
Company or organisations’ name		
Legal form 		
Date of registration		
Country of registration		
Registration number		
VAT number		
Address of registered office 		
Contact address (if different)		
URL		
			
2. TENDERERS’ REPRESENTATIVE(S) 	
Person authorised to sign the contract on behalf of the tenderer:	
Name		
Forename		
Position 		
Telephone 		
Fax 		
Email 		
Contact person regarding this tender:	
Name		
Forename		
Position 		
Telephone 		
Fax 		
Email 		
Signed (authorised signature) on behalf of the Tenderer
Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

FORM A.2 – LEGAL ENTITIES FORM
A standard template in each EU language is available at:
http://ec.europa.eu/budget/execution/legal_entities_en.htm 
Please choose the appropriate form (legal entity form for either individuals, private companies or public entities) and attach the necessary supporting documents as required (see instructions in the file). 

FORM A.3 – BANK IDENTIFICATION FORM
A standard template in each EU language is available at:
http://ec.europa.eu/budget/execution/ftiers_en.htm

FORM A.4 – POWER OF ATTORNEY
(DESIGNATING ONE OF THE COMPANIES OF THE GROUP AS LEADER AND GIVING A MANDATE TO IT)
We, the undersigned:
– Signatory 1 (Name, Function, Company, Registered address, VAT Number)
– Signatory 2 (Name, Function, Company, Registered address, VAT Number)
– …..
– Signatory N (Name, Function, Company, Registered address, VAT Number),
Each of them having the legal capacity required to act on behalf of his/her company,
HEREBY AGREE AS FOLLOWS:
1.	In case the European Union Agency for Fundamental Rights awards the Contract F-SE-14-T07 (the Contract) to Company 1, Company 2, …, Company N (the Group Members), based on the joint offer submitted by them on [to be completed] for the provision of Services the Services, all the partners, as co-signatories of the Contract:
a.	Shall be jointly and severally liable towards the European Union Agency for Fundamental Rights for the performance of the Contract.
b.	Shall comply with the terms and conditions of the Contract and ensure the proper execution of their respective share of the services.
2.	To this effect, the Group Members designate Company [to be completed] as Group Leader. 
3.	Payments by the European Union Agency for Fundamental Rights related to the Supplies or the Services shall be made through the Group Leader’s bank account.
4.	The Group Members grant to the Group Leader all the necessary powers to act on their behalf in connection with the services. This mandate involves in particular the following tasks :
a.	The Group Leader shall sign any contractual documents — including the Contract — and issue any invoices related to the services on behalf of the Group Members.
b.	The Group Leader shall act as single point of contact for the European Union Agency for Fundamental Rights in connection with the services to be provided under the Contract. It shall co-ordinate the provision of the services by the Group Members to the European Union Agency for Fundamental Rights, and shall see to a proper administration of the Contract.
Any modification to the present agreement / power of attorney shall be subject to approval from the European Union Agency for Fundamental Rights.
This agreement / power of attorney shall expire when all the contractual obligations of the Group Members towards the European Union Agency for Fundamental Rights in connection with the services to be provided under the Contract have ceased to exist. The parties cannot terminate it before that date without the consent of the European Union Agency for Fundamental Rights.

Signed in	…………………… on ……….. ……..
Name		……………………………………………
Function	……………………………………………
Company	……………………………………………

FORM A.5 – STATEMENT ON SUBCONTRACTING
Please indicate (by ticking the appropriate box) whether the tenderer intends to subcontract all or part of the performance of the Contract, if awarded. 
□	YES, the tenderer intends to subcontract all or part of the performance of the Contract, if awarded.
□	NO, the tenderer does not intend to subcontract all or part of the performance of the Contract, if awarded.
If YES, please specify which parts of the Contract, and the name and address of any subcontractor(s).
Description	Percentage of the contract	Subcontractor	
	%	Name:
Address:	
	%	Name:
Address:	
	%	Name:
Address:	
	%	Name:
Address:	
Signed (authorised signature) on behalf of the Tenderer
Full name:	………………………………………
Date:		………………………………………
Signature:	……………………………………...	Stamp:	………………………………………..

FORM A.6 – LETTER OF INTENT FOR SUBCONTRACTORS
The undersigned: 
[complete]
Name of the company/organisation: 
[complete]
Address: 
[complete]
Tender reference:
F-SE-14-T07
Declares hereby that, in case the contract is awarded to [name of the tenderer], the company/organisation that he/she represents, intends to collaborate in the execution of the tasks subject to this call for tender, in accordance with the technical specifications and the tender to which the present form is annexed, and is available to carry out its part of the tasks during the period foreseen for the execution of the contract.  
Declares hereby accepting the General Conditions of the Draft Contract attached to the invitation to tender for the above call for tenders, and in particular, those provisions referring to subcontracting and check and audits.

Place and date:	……………………………………………

Name and signature:	……………………………………………
SECTION B – EXCLUSION CRITERIA

FORM B.1 - DECLARATION OF HONOUR WITH RESPECT TO THE EXCLUSION CRITERIA AND ABSENCE OF CONFLICT OF INTEREST
The undersigned (insert name of the signatory of this form):
•	in [his][her] own name (for a natural person)
or
•	representing the following legal person: (only if the economic operator is a legal person)
full official name:
official legal form:
full official address:
VAT registration number:
declares that [the above-mentioned legal person][he][she] is not in one of the following situations:
a)	is bankrupt or being wound up, is having its affairs administered by the courts, has entered into an arrangement with creditors, has suspended business activities, is the subject of proceedings concerning those matters, or is in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
b)	has been convicted of an offence concerning professional conduct by a judgment of a competent authority of a Member State which has the force of res judicata;
c)	has been guilty of grave professional misconduct proven by any means which the contracting authorities can justify including by decisions of the European Investment Bank and international organisations;
d)	is not in compliance with all its obligations relating to the payment of social security contributions and the payment of taxes in accordance with the legal provisions of the country in which it is established, with those of the country of the contracting authority and those of the country where the contract is to be performed;
e)	has been the subject of a judgement which has the force of res judicata for fraud, corruption, involvement in a criminal organisation, money laundering or any other illegal activity, where such activity is detrimental to the Union's financial interests;
f)	is subject to an administrative penalty for being guilty of misrepresenting the information required by the contracting authority as a condition of participation in a grant award procedure or another procurement procedure or failing to supply this information, or having been declared to be in serious breach of its obligations under contracts or grants covered by the Union's budget.
•	(Only for legal persons other than Member States and local authorities, otherwise delete) declares that the natural persons with power of representation, decision-making or control over the above-mentioned legal entity are not in the situations referred to in b) and e) above; 
•	declares that [the above-mentioned legal person][he][she]:
g)	has no conflict of interest in connection with the contract; a conflict of interest could arise in particular as a result of economic interests, political or national affinity, family, emotional life or any other shared interest;
h)	will inform the contracting authority, without delay, of any situation considered a conflict of interest or which could give rise to a conflict of interest;
i)	has not granted and will not grant, has not sought and will not seek, has not attempted and will not attempt to obtain, and has not accepted and will not accept any advantage, financial or in kind, to or from any party whatsoever, where such advantage constitutes an illegal practice or involves corruption, either directly or indirectly, inasmuch as it is an incentive or reward relating to award of the contract;
j)	provided accurate, sincere and complete information to the contracting authority within the context of this procurement procedure ;
•	acknowledges that [the above-mentioned legal person][he][she] may be subject to administrative and financial penalties if any of the declarations or information provided prove to be false. 
In case of award of contract, the following evidence shall be provided upon request and within the time limit set by the contracting authority:

For situations described in (a), (b) and (e), production of a recent extract from the judicial record is required or, failing that, a recent equivalent document issued by a judicial or administrative authority in the country of origin or provenance showing that those requirements are satisfied. Where the tenderer is a legal person and the national legislation of the country in which the tenderer is established does not allow the provision of such documents for legal persons, the documents should be provided for natural persons, such as the company directors or any person with powers of representation, decision making or control in relation to the tenderer.
For the situation described in point (d) above, recent certificates or letters issued by the competent authorities of the State concerned are required. These documents must provide evidence covering all taxes and social security contributions for which the tenderer is liable, including for example, VAT, income tax (natural persons only), company tax (legal persons only) and social security contributions.
For any of the situations (a), (b), (d) or (e), where any document described in two paragraphs above is not issued in the country concerned, it may be replaced by a sworn or, failing that, a solemn statement made by the interested party before a judicial or administrative authority, a notary or a qualified professional body in its country of origin or provenance.
If the tenderer is a legal person, information on the natural persons with power of representation, decision making or control over the legal person shall be provided only upon request by the contracting authority. 

Full name:……………………………..  Date:……………………………

Signature:……………………………..  Stamp:…………………………
SECTION C – SELECTION CRITERIA (ECONOMIC AND FINANCIAL CAPACITY)

1 - Internet services

FORM C.1 – STATEMENT OF ANNUAL TURNOVER
Please fill in the table below in accordance with the instructions provided in Annex A – Tender Specifications: 
Statement on annual overall turnover (in EURO)	
Tenderer’s name	Current year -2	Current year -1	
Partner 1			
Partner 2			
Etc…			
Total			
(please add rows and columns if needed).] 

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

2 - VoIP telephony

FORM C.1 – STATEMENT OF ANNUAL TURNOVER
Please fill in the table below in accordance with the instructions provided in Annex A – Tender Specifications: 
Statement on annual overall turnover (in EURO)	
Tenderer’s name	Current year -2	Current year -1	
Partner 1			
Partner 2			
Etc…			
Total			
(please add rows and columns if needed).] 

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

3 - Mobile telephony

FORM C.1 – STATEMENT OF ANNUAL TURNOVER
Please fill in the table below in accordance with the instructions provided in Annex A – Tender Specifications: 
Statement on annual overall turnover (in EURO)	
Tenderer’s name	Current year -2	Current year -1	
Partner 1			
Partner 2			
Etc…			
Total			
(please add rows and columns if needed).] 

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

SECTION D – SELECTION CRITERIA (TECHNICAL AND PROFESSIONAL CAPACITY)

1 - Internet services

FORM D.1 – LIST OF PRINCIPAL SERVICES PROVIDED/SUPPLIES DELIVERED
Please complete a table using the format below to summarise the major relevant services provided/supplies delivered relevant to this contract in the last two (2) years. Please include one table per project.

Name of legal entity performing the project:		
Project name:		
Client:		
Country:		
Project value (euro):	<Total project value>	
Resources used:	<Total number of person days> or <Number of staff provided>	
Project duration :	From:                           To:                   Duration:   (months)	
Name of consortium partners, if any:		
Project Description:	<Please provide a summary of the project objectives and a description of the main tasks>

(if space not sufficient please adapt the table)

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

2 - VoIP telephony

FORM D.1 – LIST OF PRINCIPAL SERVICES PROVIDED/SUPPLIES DELIVERED
Please complete a table using the format below to summarise the major relevant services provided/supplies delivered relevant to this contract (at least three SIP trunk/VOIP projects where minimum one is MS Lync 2010 or later of an amount/nature or scope similar to the services to be carried out under this tender)Please include one table per project. 

Name of legal entity performing the project:		
Project name:		
Client:		
Country:		
Project value (euro):	<Total project value>	
Resources used:	<Total number of person days> or <Number of staff provided>	
Project duration :	From:                           To:                   Duration:   (months)	
Name of consortium partners, if any:		
Project Description:	<Please provide a summary of the project objectives and a description of the main tasks>

(if space not sufficient please adapt the table)

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

3 - Mobile telephony

FORM D.1 – LIST OF PRINCIPAL SERVICES PROVIDED/SUPPLIES DELIVERED
Please complete a table using the format below to summarise the major relevant services provided/supplies delivered relevant to this contract in the last two (2) years. Please include one table per project.

Name of legal entity performing the project:		
Project name:		
Client:		
Country:		
Project value (euro):	<Total project value>	
Resources used:	<Total number of person days> or <Number of staff provided>	
Project duration :	From:                           To:                   Duration:   (months)	
Name of consortium partners, if any:		
Project Description:	<Please provide a summary of the project objectives and a description of the main tasks>

(if space not sufficient please adapt the table)

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

SECTION E – FINANCIAL GUARANTEES
This section is not applicable to this tender.

	
SECTION F – FINANCIAL OFFER

Lot 1 - Internet services
FORM F.1 – FINANCIAL OFFER TEMPLATE
[To be submitted in a separate sealed envelope clearly stating "Financial Offer" following the instructions laid down in Annex A – Tender Specifications]
F-SE-14-T07
Provision of Internet, Voip & Mobile Services
IDENTIFICATION OF THE TENDERER:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
Financial proposal in Euro 10
(based on the information given in Annexes A and A.1 covering financial award criteria)	
Item	Price 11	
	For evaluation purposes tenderers must provide prices for all items listed in the grid below.		
1.	Monthly fee primary internet service 24 Mbps unlimited. The fee shall include the following services described in Annex A1 Technical  Specifications: 5.1.1 - 5.1.8		
2.	Monthly fee Backup Internet connection 12 Mbps. The service fee shall include the local loop as well.		
3.	Increase of primary internet service bandwidth of 8 Mbps		
4.	Installation fee primary internet service		
5.	Installation backup internet service		
	TOTAL		
  
Signed (authorised signature) on behalf of the Tenderer

Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

10All prices must be quoted in Euro, and, where necessary, using the conversion rates published in the C series of the Official Journal of the European Union on the day when the offer is issued. This information is also available on the website of the European Central Bank at the following URL: http://www.ecb.int/stats/eurofxref/
11Prices must be inclusive of all costs and expenses, directly and indirectly connected with the services to be provided and including all the charges (like overheads, travel and subsistence allowances, project management fees, quality control, back-up services, etc.). The financial proposal shall exclude all duties, taxes and other charges (including VAT), as FRA is exempt from such charges. According to Articles 3 and 4 of the Protocol on the Privileges and Immunities of the European Communities, the Communities are exempt from all charges, taxes and dues, including value added tax; such charges may not therefore be included in the calculation of the price quoted

Lot 2 - VoIP telephony
FORM F.1 – FINANCIAL OFFER TEMPLATE
[To be submitted in a separate sealed envelope clearly stating "Financial Offer" following the instructions laid down in Annex A – Tender Specifications]
F-SE-14-T07
Provision of Internet, Voip & Mobile Services
IDENTIFICATION OF THE TENDERER:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………

Financial proposal in Euro 10
(based on the information given in Annexes A and A.1 covering financial award criteria)	
Item	Price 11	
1.	Monthly fee for the provision of VOIP services as described in Annex A1 Technical specifications.		
2.	Installation fee 		
	TOTAL		
  
Signed (authorised signature) on behalf of the Tenderer

Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………
10All prices must be quoted in Euro, and, where necessary, using the conversion rates published in the C series of the Official Journal of the European Union on the day when the offer is issued. This information is also available on the website of the European Central Bank at the following URL: http://www.ecb.int/stats/eurofxref/
11Prices must be inclusive of all costs and expenses, directly and indirectly connected with the services to be provided and including all the charges (like overheads, travel and subsistence allowances, project management fees, quality control, back-up services, etc.). The financial proposal shall exclude all duties, taxes and other charges (including VAT), as FRA is exempt from such charges. According to Articles 3 and 4 of the Protocol on the Privileges and Immunities of the European Communities, the Communities are exempt from all charges, taxes and dues, including value added tax; such charges may not therefore be included in the calculation of the price quoted

Lot 3 - Mobile telephony
FORM F.1 – FINANCIAL OFFER TEMPLATE
[To be submitted in a separate sealed envelope clearly stating "Financial Offer" following the instructions laid down in Annex A – Tender Specifications]
F-SE-14-T07
Provision of Internet, Voip & Mobile Services
IDENTIFICATION OF THE TENDERER:
Name: ……………………………………………
Contact person: ……………………………………
Address: ……………………………………………
Phone: ……………………………………………
Fax: ……………………………………………
Email: ……………………………………………
 
Financial proposal in Euro 10
(based on the information given in Annexes A and A.1 covering financial award criteria / sub-criteria)	
Item	Category	Price 11	
1.	Basic fee
Including: Unlimited minutes to all fixed and mobile numbers within the HQ zone (Austria); min. of 1000 SMS within the HQ zone; min. of 200 min from HQ zone to EU-28 zone; min. of 5GB data traffic withiwin the HQ zone with a min. download rate of 21Mbp/s			
2.	HQ zone to EU-28 zone (price/minute, 60/60 model)			
3.	FRA Mobile to FRA Mobile-  EU-28 (price/minute, 60/60 model) – ACTIVE  ROAMING CALLS			
4.	FRA Mobile to FRA Mobile -  EU-28 (price/minute, 60/60 model) – PASSIVE ROAMING CALLS			
5.	FRA Mobile to FRA fixed - EU-28 (price/minute, 60/60 model) – ACTIVE ROAMING CALLS			
6.	FRA Mobile to FRA fixed - EU-28 (price/minute, 60/60 model) – PASSIVE ROAMING CALLS			
	TOTAL			
 Signed (authorised signature) on behalf of the Tenderer

Full name:……………………………………..
Date:……………………………………………
Signature:……………………………………...	Stamp:………

10All prices must be quoted in Euro, and, where necessary, using the conversion rates published in the C series of the Official Journal of the European Union on the day when the offer is issued. This information is also available on the website of the European Central Bank at the following URL: http://www.ecb.int/stats/eurofxref/
11Prices must be inclusive of all costs and expenses, directly and indirectly connected with the services to be provided and including all the charges (like overheads, travel and subsistence allowances, project management fees, quality control, back-up services, etc.). The financial proposal shall exclude all duties, taxes and other charges (including VAT), as FRA is exempt from such charges. According to Articles 3 and 4 of the Protocol on the Privileges and Immunities of the European Communities, the Communities are exempt from all charges, taxes and dues, including value added tax; such charges may not therefore be included in the calculation of the price quoted