SELF-ASSESSMENT QUESTIONNAIRE

IFAD/2015/020/RFP
BORROWER PORTAL SOFTWARE
DEVELOPMENT

BIDDERs
SELFASSESSMENT
QUESTIONNAIRE
IMPORTANT
This form will not be considered valid unless it is signed and
stamped on the last page

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SELF-ASSESSMENT QUESTIONNAIRE

Notes for Bidders1

The purpose of this questionnaire is to assist IFAD in evaluating bids received for
this tender.
In order to make this simple, you dont need to provide any supporting documents
at this stage.
However, we may ask to see these documents at a later stage. You may
also be asked to clarify your answers or provide more details, especially if
there are a significant number of NO responses in the completed
questionnaire..
Please answer every question. If the question does not apply to you please write
N/A; if you dont know the answer please write N/K.
Please upload this form onto the IFAD e-tendering system together
with the other documents of your proposal.

IMPORTANT
This form will not be considered valid unless it is signed and
stamped on the last page
If you have any queries about this form please contact:
d.lee@ifad.org

This standard self-assessment questionnaire for contract opportunities is based on the UK

Office of Government Commerce & Small Business Service model document, adapted to
IFADs needs.
Ver May 2014
1

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SELF-ASSESSMENT QUESTIONNAIRE

SELF-ASSESSMENT QUESTIONNAIRE
1

BASIC DETAILS OF YOUR ORGANISATION2

1.1

Name and address of the

company in whose name
the tender would be
submitted and that
eventually would sign the
contract if awarded:
Company website address
(if available):
Company Registration
number (Chamber of
Commerce or Certificate of
Incorporation)
UNGM3 registration
number (www.ungm.org)
(if already registered)
Tax / VAT number
Dun & Bradstreet D-U-N-S
number (if available)
Is your organization a notfor profit entity (or
similar)?
If so, in which countries is
it recognised as such?

1.2
1.3

1.4
1.5
1.6
1.7

CONTACT INFORMATION FOR THIS TENDER

1.2
1.3

Contact name for enquires

about this bid:
Contact position (Job Title)

1.4

Telephone numbers:

1.5

E-mail address:

3
3.1

FINANCIAL INFORMATION
What was your turnover in the last two years (if this applies)
:________

:________

for year ended __________

for year ended __________

If this does not apply, what year did you commence business? ____________
3.2
Has your organisation met the terms of its banking
facilities and loan agreements (if any) during the
Yes / No
past year?
3.3
If No what were the reasons, and what has been done to put things right?

An electronic company check (through the Chamber of Commerce, Dun & Bradstreet, etc)
may be undertaken by IFAD as part of this pre-qualification process
3
United Nations Global Marketplace website www.ungm.org
2

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SELF-ASSESSMENT QUESTIONNAIRE

3.4

Has your organisation met all its obligations to pay

its creditors and staff during the past year?

3.5

If No please explain why not:

Yes / No

BUSINESS ACTIVITIES

4.1

What are the main business activities of your organisation?

4.2

How many staff does your organisation have?

(If you are a sole trader, please say so)

4.3

Kindly describe your professional expertise and business strengths in the

services requested by IFAD with this tender.

5.1

REFERENCES
Please provide details of three recent contracts that are relevant to IFADs
requirement. Where possible at least one should be from the public sector. If
you cannot provide three references, please explain why.
Reference 1
Reference 2
Reference 3
Customer
Organisation
(name):

5.2

Customer contact
name and phone
number:

5.3

Date contract
awarded:

5.4

Contract reference
and brief
description:

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SELF-ASSESSMENT QUESTIONNAIRE
5.5

Value:

5.6

Date contract was

completed

5.7

Have you had any contracts terminated for poor

performance in the last three years, or any
contracts where damages have been claimed by
the contracting authority?
If Yes please give details:

5.8

INSURANCE

6.1
a)

Please provide details of your current insurance cover:

Employers Liability (Min 5m)

b)

Civil/Public Liability (Min 5m)

c)

Other (please provide details)

7
7.1

Yes / No

Value
________
Value
________
Value
________

QUALITY ASSURANCE
Does your organisation hold a recognised quality
management certification for example BS/EN/ISO
9000:2000 or equivalent?

Yes / No

If Yes please state name of certification

7.2

_______________________________________.
If No, does your organisation have a quality
management system*?

Yes / No

If you do not have quality certification or a quality

management system, please explain why:

8
8.1
8.2
8.3

PROFESSIONAL AND BUSINESS STANDING

Do any of the following apply to your organisation, or to (any of) the
director(s) / partners / proprietor(s)?
Is in a state of bankruptcy, insolvency, compulsory
winding up, receivership, composition with creditors,
Yes / No
or subject to relevant proceedings
Has been convicted of a criminal offence related to
business or professional conduct
Yes / No
Has committed an act of grave misconduct in the
course of business

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Yes / No

SELF-ASSESSMENT QUESTIONNAIRE

8.4

Has not fulfilled obligations related to payment of

social security contributions

Yes / No

8.5

Has not fulfilled obligations related to payment of

taxes

Yes / No

8.6

Is guilty of serious misrepresentation in supplying

information

Yes / No

8.7

Is not in possession of relevant licences or

membership of an appropriate organisation where
Yes / No
required by law.
If the answer to any of these questions is Yes please give brief details
below, including what has been done to put things right.

8.8

ACCEPTANCE OF IFAD GENERAL TERMS &

CONDITIONS
All contracts entered into by IFAD are subject to IFADs General Terms
and Conditions for the Procurement of Goods/Services, attached to this
tender. They shall form an integral part of any contract between the
Supplier and IFAD, together with any conditions included in this tender
and its annexes. Non acceptance by Bidders of any of the general terms
and conditions must be accompanied by an appropriate explanation.
IFAD reserves the right to reject bids that demonstrate non compliance.

9.1
9.2
9.3

9.4

9.5

Have you read and understood the Draft Contract

attached to this tender, containing the IFAD General
Yes / No
Terms and Conditions?
Do you accept all the clauses of the Draft Contract and
Yes / No
the IFAD General Terms and Conditions
If you answered NO to the above, what are your reservations?

Payment Terms: According to art.7 of the IFAD General Terms and

Conditions and unless expressly stipulated otherwise in the Contract, IFAD
shall make payment by means of a bank remittance within 30 days of
receiving the invoice and any other documents specified in the Contract or
within 30 days of the date on which performance of the Contract was
satisfactorily completed, whichever is the latest dated one.
Do you accept these payment conditions?
Yes / No
If you answered NO to the above, what are your reservations?

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SELF-ASSESSMENT QUESTIONNAIRE

10

SUB-CONTRACTING & GROUPING

Please provide details of any subcontractor that will be involved in the
service delivery (if any) COMPANY NAME, address, owner, role.
In case of temporary grouping on companies, please provide a detailed
description.

10.1
10.2
10.3

11

DELIVERY, WARRANTY, INSURANCE

(if applicable, mainly for goods and works)

11.1

Fill in this part if applicable to the object of the tender

DELIVERY TERMS

11.2

WARRANTY TERMS

11.3

INSURANCE FOR
GOODS & WORKS

12

VALIDITY OF YOUR PROPOSAL FOR OTHER UN

ORGANIZATIONS, INCLUDING FAO AND WFP
Bidders should also note that all responses may be shared with and viewed
by other UN Organizations, in particular the Rome-based UN agencies and
organisations (i.e. FAO and WFP), which could be involved in the evaluation
process, or being interested in adopting the contract established by IFAD.

12.1

12.2

13

Please specify whether your Proposal can be extended,

at the same terms and conditions, to other United
Nations Organizations, such as the Food and
Agricultural Organization (FAO) or the World Food
Programme (WFP).

Yes / No

If not, please provide a comment on possible

restrictions.

POTENTIAL CONFLICT OF INTEREST

Bidders should disclose any potential conflict of interest of people involved
in the preparation of the vendors proposal and in the future delivery to
IFAD of goods, services or works.
Two example of potential conflict of interest could be: involvement of family
members or relatives of any IFAD employees; or involvement of a former

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SELF-ASSESSMENT QUESTIONNAIRE
IFAD staff member. In the above case, IFAD reserve the right to evaluate
the situation.
13.1

Please provide detail below:

14. DECLARATION
I declare that to the best of my knowledge the answers submitted in this questionnaire (and
any supporting modules) are correct. I understand that the information will be used in the
evaluation process to assess my organisations suitability to be invited to tender for the
IFADs requirement.

FORM COMPLETED BY
Organisation Name:
Name:
Position (Job Title):
Email:
Telephone numbers
(office, mobile):
Date:
Signature and stamp:

IMPORTANT
This form will not be considered valid unless it is signed and
stamped on this page.

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