D-Template Declaration of Honour relating to Exclusion ... - Europa

GSA/NP/09/12- “EGNOS Service Provision”Annex D to Tender Information Package- Declaration of Honour form relating toExclusion Criteria1 of 5Annex D to TIP of GSA/NP/09/12 -“ESP”

(a) DeclarationTo be eligible for participating in this contract award procedure, Candidates (all entitiesinvolved, including envisaged sub-contractors, other than incumbent and mandatory subcontractorsdefined in Annex B to tender Information Package (Statement of Work)) who wantto perform tasks under the Direct Service Contract there under must submit the followingExclusion Criteria Form 1 :EXCLUSION CRITERIA FORMThe undersigned (economic operator):.............................................................................................................................Name of company or organisation:.............................................................................Official address in full:.......................................................................................................................................................................................................................................................................................................................................................................................Official legal form: ...................................................................................................Statutory registration number: .................................................................................VAT number: ..........................................................................................................Name of person signing this form (designated individual legally authorised to represent theCandidate or the Tenderer in dealings with third parties and acting on behalf of the abovecompany or organisation):.............................................................................................................................declares that the company or organisation that he/she represents:a) is not bankrupt or being wound up, is not having its affairs administered by thecourts, has not entered into an arrangement with creditors, has not suspendedbusiness activities, is not the subject of proceedings concerning those matters, andis not in any analogous situation arising from a similar procedure provided for innational legislation or regulations;1 Article 93 of Council Regulation (EC, Euratom) No 1605/2002 of 25 June 2002 on the Financial Regulation applicableto the general budget of the European Communities (OJ L 248 of 16.9.2002).2 of 5Annex D to TIP of GSA/NP/09/12 -“ESP”

(b) Supporting documents to the Exclusion Criteria FormThe Candidates who have successfully passed Phase I of this procurement procedure and havebeen invited as Tenderers to Phase II, must submit the following evidence confirming theDeclaration of Honour above (in case of subcontractor(s) envisaged to perform morethan 20% of the total contract value the declaration has to be provided individually byeach respective subcontractor) at the same time with the submission of the initial offer inPhase II:Ref.CriterionCriterionfulfilled(yes/no)1. GSA shall accept, as satisfactory evidence that theTenderer/Subcontractor is not in one of the situations described inpoint (a), (b) or (e) of the Exclusion Criteria Form, the production of arecent extract from the judicial record or, failing that, a recentequivalent document issued by a judicial or administrativeauthority in the country of origin or provenance showing that thoserequirements are satisfied.2. GSA accepts, as satisfactory evidence that theTenderer/Subcontractor is not in the situation described in point (d) ofthe Exclusion Criteria Form, a recent certificate issued by thecompetent authority of the State concerned.3. Where the document or certificate referred to in Ref. 1 & 2 is notissued in the country concerned and for the other cases of exclusionreferred to in the Exclusion Criteria Form, it may be replaced by asworn or, failing that, a solemn statement made by the interestedparty before a judicial or administrative authority, a notary or aqualified professional body in his country of origin or provenance.4. Depending on the national legislation of the country in which theTenderer/Subcontractor is established, the documents referred to in Ref. 1, 2, 3 shallrelate to legal persons and/or natural persons including, where necessary, companydirectors or any person with power of representation, decision-making or control inrelation to the tenderer/subcontractor. This would be the case when the nationallegislation concerned gives juridical responsibility of the acts committed by a legalentity (moral persons) to their legal representatives. The Tenderer/Subcontractor shallprovide information on the ownership or on the management, control and power ofrepresentation of the legal entity whenever necessary for the proper understanding ofthe evidence submitted or whenever the GSA requests it4 of 5Annex D to TIP of GSA/NP/09/12 -“ESP”

5. Where there are doubts as to whether Tenderer/Subcontractor is in one of thesituations of exclusion, the GSA may itself apply to the competent authorities referredto in Ref. 3 to obtain any information they consider necessary about that situation.6. The GSA may waive the obligation of a Tenderer/Subcontractor to submit thedocumentary evidence referred to in Ref. 1 and 2 if such evidence has alreadybeen submitted to it for the purposes of another procurement procedure and providedthat the issuing date of the documents does not exceed one year and that they arestill valid. In such a case, the Candidate/Subcontractor shall declare on his honourthat the documentary evidence has already been provided to the GSA in a previousprocurement procedure and confirm that no changes in his situation have occurred. Heshall indicate in its tender all the references necessary to allow the GSA to check thisevidence.7. Tenderer/Subcontractor may refer to the e-Certis web-site listing the certificatesavailable in EU Member States:http://ec.europa.eu/markt/ecertis/login.doStamp, date and signature of the authorised representative of the economic operator5 of 5Annex D to TIP of GSA/NP/09/12 -“ESP”