expressions of interest application for service providers ... · maintenance of properties that...
TRANSCRIPT
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Expressions of interest Application for
Service Providers Panel
Registration
Information and Response Package
For the
Provision of Goods and Services
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Table of contents
1. Objective ..............................................................................................................................................3
2. Background...........................................................................................................................................3
3. How to Respond to This Invitation.......................................................................................................4
4. Submission of EOI.................................................................................................................................6
5. Confidentiality ......................................................................................................................................6
6. Conflict of Interest................................................................................................................................7
7. Prohibitions ..........................................................................................................................................7
8. National Code of Practice for the Construction Industry.....................................................................7
9. Duration of Panel Arrangements .........................................................................................................8
10. Providers to Note.............................................................................................................................8
11. Evaluation ........................................................................................................................................8
12. Evaluation Procedures ..................................................................................................................... 9
13. Evaluation Criteria............................................................................................................................9
14. Evaluation Stages ...........................................................................................................................10
15. Glossary of Terms .......................................................................................................................... 11
16. Appendix A: Application Form and Declaration.............................................................................13
17. Appendix B: Response Statement..................................................................................................16
18. Appendix C Compliance to Industry Standards: ............................................................................20
19. Appendix D Geographical locations:..............................................................................................21
20. Appendix E Conflict of interest Form:............................................................................................23
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Request for Expression of Interest
for the Provision of Goods and Services to NSW Trustee and Guardian.
1. Objective 1.1.1 The aim of this Expressions of Interest (EOI) is to provide an opportunity for
potential contractors/consultants to be pre-qualified on a panel arrangement which are to be used to invite firms to tender/quote for the provision of services for Clients of NSW Trustee and Guardian.
Note: It is NSW Trustee and Guardian’s intention to register the selected EOI providers for a period of 2 years.
2. Background 2.1.1 NSW Trustee and Guardian (NSWTG) commenced operations on 1 July 2009,
merging the organisations previously known as the Office of the Protective Commissioner, Office of the Public Guardian and the Public Trustee. NSW Trustee and Guardian has five core business areas: Deceased Estate Administration Financial Management Powers of Attorney Services Trust Management Will making
2.1.2 Inherent in all business areas, other than will making, is the need for management of assets. This includes real property, vehicles, personal assets and other non-financial assets. NSW Trustee and Guardian has the fiduciary responsibility to ensure appropriate management of individual client assets. The organisation aims for and expects the highest level of accountability and transparency in its operations and applies probity controls when engaging external agents to undertake aspects of operations.
2.1.3 NSW Trustee and Guardian engages external service providers in a variety of areas for the appropriate management of our client’s assets. A panel will be established by means of expressions of interest from appropriately qualified individuals, businesses and companies. The services sought are at the discretion of NSW Trustee and Guardian and there is no guarantee of work for panel members.
2.1.4 NSW Trustee and Guardian is required to provide services at a high standard. The expectation for external agents employed to undertake work on behalf of our clients is that they will perform to a similarly high standard for each individual client. This means that all Australian Standards, Codes and Legislation will be met or surpassed; only qualified persons will undertake work and an accountability framework will be in place to ensure that work meets expectations.
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Geography
2.1.5 Client properties are located mainly within NSW, although a number are located in other States and Territories and internationally. The panel arrangements are to be established only for those properties in NSW. All interested parties should indicate as part of their expression of interest which geographic areas they are able to provide services. The state has been divided into Region, Area and Local Government Areas (LGA). A list of these is provided as Appendix E. Interested parties need to indicate which regions, areas or LGA’s they are able to provide services for.
Client Base
2.1.6 The client base for NSW Trustee and Guardian is varied. For the management of estates, NSW Trustee and Guardian may need to organise repairs and maintenance of properties that form part of the NSW portfolio. Instructions for repairs and maintenance will be issued by NSW Trustee and Guardian to the external service provider and all invoices, quotations and queries are to be referred to the organisation as opposed to an individual client.
3. How to Respond to This Invitation
3.1.1 Contact Officer (a) All enquiries regarding this Expression of Interest should be directed via email to:
(b) Please quote the Provision of Service/s, your Region/s. National/State or States/Regions and if applicable a Reference Number on the subject line of the email. (c) Any contact with any other NSW Trustee and Guardian staff member relating to this EOI other than through the designated Contact may, at the absolute discretion of the Client Assets Division Assistant Director, invalidate the EOI submission.
3.1.2 Documents to be Lodged
Providers are required to fully complete and return the following documents:
a. Cover Sheet;
b. Application Form (Appendix A);and
c. Response Statements (Appendix B, C, D, E );
Providers may also provide any information they consider relevant to their application in addition to the required documentation.
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3.1.3 Lodgement Requirements
Expression of Interests should be emailed clearly identifying:
Expression of Interest
NSW Trustee and Guardian - Client Assets Division
[Nominate your Category, Region; Regions or National]
Expression of Interest must be submitted electronically to the following email address.
Responses lodged by fax or post will not be accepted.
3.1.4 Copies of Proposals
The electronic emailed EOI response will be considered the original and NSW Trustee and Guardian advises that controlled copies may be printed for evaluation purposes.
3.1.5 Rights
NSW Trustee and Guardian may:
a. amend this EOI;
b. require additional information or clarification from Providers;
c. provide additional information or clarification to Providers;
d. negotiate with any one or more Providers including terminating any negotiations being conducted from time to time;
e. not release an RFT/RFQ
f. change the structure and timing of the EOI process at any time, NSW Trustee and Guardian can terminate the EOI process if:
(i) No response meets the minimum content and format requirements (e.g. Mandatory requirements about responses);
(ii) No Respondent meets the conditions for participation (e.g. mandatory requirements about Providers (such as the Respondent holding a particular License);or
(iii) No response represents value for money.
3.1.6 If NSWTG terminates the EOI process, NSW Trustee and Guardian may:
a. negotiate with any one or more of the Providers or any other person for the Supply of all, or any, of the services;
b. call for new proposals;
c. engage in any other selection process for the supply of the services;
d. add to, alter, delete or exclude any services;
e. short list Providers;
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f. enter into any arrangements which will best meet NSW Trustee and Guardian’s needs;
g. allow a Respondent to correct an unintentional error or form in a response; and
h. suspend the EOI (on the same basis as termination).
3.1.7 Nothing in this EOI or arising from the EOI process shall give rise to any contractual obligations binding NSW Trustee and Guardian (including a process contract).
3.1.8 No response will be taken to have been accepted and listed on the Panel unless a Service Level Agreement and/ or written notification has been received and agreed by both parties. Any conduct or statement by NSW Trustee and Guardian whether prior to or subsequent to the issue of the EOI is not, and must not be deemed to be:
a. An offer to enter into any formal agreement/contact.
b. A binding undertaking of any kind by NSW Trustee and Guardian (including, without limitation, an undertaking that could give rise to quasi-contractual rights, promissory estoppels or rights with a similar legal basis).
4. Submission of EOI
All submissions are to be received via email by COB 30 September 2013.
Late submissions may not be accepted.
5. Confidentiality
5.1.1 All information submitted with a Respondent’s submission will be treated as Confidential.
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6. Conflict of Interest
6.1.1 Providers, at the time of lodging their proposal, must declare any conflict of interest that exists, or is likely to arise, which would affect the performance of their obligations, if the Respondent were to enter into a contract with NSW Trustee and Guardian.
6.1.2 In the event of a conflict of interest being identified NSW Trustee and Guardian
may, at its discretion, exclude the application from further consideration where conflict exists.
6.1.3 Providers are to read and complete Appendix E.
7. Prohibitions 7.1.1 Providers must not:
a. Make false or misleading statements;
b. Receive improper assistance from NSW Trustee and Guardian employees;
c. Engage in collusive tendering or anti-competitive conduct; or
d. attempt to improperly influence NSW Trustee and Guardian’s employees.
8. National Code of Practice for the Construction Industry (Building Maintenance and Construction only)
8.1.1 The Respondent’s attention is drawn to the National Code of Practice for the Construction Industry (Code).
8.1.2 By submitting an expression of interest to undertake the work/services you:
a. will be deemed to have read; and
b. agree that you must comply with the Code and Guidelines.
8.1.3 It is a condition of the EOI that Providers comply with the Code and Guidelines.
8.1.4 As part of their EOI response, Providers must submit a signed “Declaration of Compliance” in accordance with the Declaration of Compliance which is attached to this Expression of Interest. (refer to Annexure C)
8.1.5 A failure to meet these conditions for participation will mean that the Respondent will be automatically excluded from the EOI.
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9. Duration of Panel Arrangements
9.1.1 The panel of preferred providers will remain in effect for a period of two years from the date of inception, TBA.
Resultant of the EOI process, all short listed providers will sign a Service Level Agreement prior to being a registered Panel Service Provider.
9.1.2 Providers may be added to the panel or removed from the panel at the sole discretion of NSW Trustee and Guardian.
9.1.3 All providers will be formally notified if the panel arrangement is to be extended.
9.1.4 Providers can elect to withdraw from the panel. All Withdrawals will be by email stating they wish to be removed from any further consideration.
10. Providers to Note
10.1.1 The EOI, or any Response to it, does not commit, obligate or otherwise create a legal relationship between NSW Trustee and Guardian and a Respondent in respect of:
a) An obligation on NSW Trustee and Guardian to issue a work order, RFQ and RFT to a Respondent;
b) NSW Trustee and Guardian entering into a contract with a Respondent; or c) The process to be followed in handling any responses.
10.1.2 In no event will NSW Trustee and Guardian be liable for any cost, expense, loss,
claim or damage arising out of a Respondent’s participation in this EOI process or any subsequent RFQ submission.
11. Evaluation 11.1.1 The decision to approve or reject a submission for evaluation is at the absolute
discretion of NSW Trustee and Guardian, who shall not be held liable for any costs incurred or damages arising out of such discretion.
11.1.2 The evaluation may involve discussions with some or all Providers to seek further
clarification of their submissions, requests to some or all Providers to provide written clarification of various aspects of their submissions and discussions with and visits to, customers of some or all Providers and their subcontractors, whether or not those customers are listed as referees in the Respondent’s submission.
11.1.3 NSW Trustee and Guardian may make independent enquiries about any matters
that may be relevant to the evaluation of a submission.
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12. Evaluation Procedures
12.1.1 NSW Trustee and Guardian will appoint an independent evaluation team to evaluate the proposals received.
12.1.2 Each Respondent grants to NSW Trustee and Guardian the right to:
d) At its discretion, NSW Trustee and Guardian Audit Team may conduct a cost analysis of the pricing structure and rates for the purposes of establishing the cost effectiveness of a sole sourced provider or where NSW Trustee and Guardian identifies a Service Provider has not submitted sufficient information;
e) Seek clarification from the Respondent in relation to any information contained in its proposal;
f) Obtain information from any referee nominated in its proposal; g) Conduct its own inquiries in relation to the Respondent or the Respondent’s
past performance; and h) Make independent enquiries about any matter that may be relevant to the
evaluation of any response.
12.1.3 EOIs are to be assessed on the basis of Value for Money as between NSW Trustee and Guardian and the Providers. Value for Money is a comprehensive assessment that takes into account both the representations made by respondent against the evaluation criteria, in the context of the risk profile presented by each response.
12.1.4 The providers submitting an EOI will be assessed against the following evaluation criteria:
13. Evaluation Criteria 13.1.1 Submissions will be evaluated against but not limited to the following criteria,
which are not specified in any order of importance:
13.1.2 Mandatory Criteria
Evidence of Insurance and validity dates:
Providers are to provide details and copies of current insurance coverage. Insurance policy details should include
the type of policy; the name of the insurer; the amount of cover; and the expiry date as a minimum.
13.1.3 Evaluation Criteria
Criterion 1: Demonstrated capability and capacity to undertake the works required.
Criterion 2: Demonstrated ability to complete works to agreed quality standards; and
Criterion 3: Schedule of rates.
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14. Evaluation Stages 14.1.1 Expressions of Interest received will be assessed as follows:
First Assessment –Mandatory Criteria evidenced The Evaluation Team will examine all the responses to validate compliance to the Mandatory requirements. If found to be non-compliant, no further consideration will be given to the application. Second Assessment – Completeness of Response and Company Profile Information i. The Evaluation Committee will examine each Respondent’s EOI for completeness. That is, examine each respondent’s submitted Appendix A, B, C, D and E to ensure sufficient information has been supplied to allow assessment. ii. Providers that do not provide any information, or the information supplied is deemed incomplete by the Evaluation Team, may be deemed non-compliant and may be excluded from any further consideration in the evaluation process. Note: The Company Profile information provided will be validated by NSW Trustee and Guardian’s Evaluation Team. Third Assessment – Code of Practice for applicable Industry i. Complying Providers from the first assessment will be assessed for Compliance with the National Code of Practice for the relevant Industry. Providers who do not comply with the relevant Code/s will not be considered further. Fourth Assessment – Suitability for Work i. Complying Providers from the second and third assessment will be evaluated against evaluation criteria 1, 2 and 3 to determine their suitability to undertake proposed work.
14.1.2 Panel Selection
NSW Trustee and Guardian will determine the membership of the panel at its discretion based on the results of the evaluation of the above assessment. Providers who are short-listed in the EOI process will:
be requested to sign a Service Level Agreement, upon receipt of the signed Service Level Agreement the Providers will
then be registered on the panel and advised formally in writing. As requirements for specific projects are identified, the Respondent may be invited to submit a RFQ/RFT proposal for consideration.
14.1.3 Selection Decision
All providers will be informed in writing of the outcome of the EOI process at its conclusion and will be offered the opportunity for a debriefing.
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This Expressions of Interest (EOI) is an “invitation to treat” and must not be interpreted, or relied upon, whether by expression or implication, or as creating any form of contractual or, rights based upon similar legal or equitable grounds.
Note: Not all Service Provider providers will be invited to submit a quotation; providers will be assessed on the Criterion outlines in section 13 and 14 of the document.
15. Glossary of Terms
EOI Expressions of Interest
RFQ Request for Quotation
Emergency An occurrence that requires immediate on site
response
RFT Request for Tender
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Disclaimer
Each Respondent, by lodging an Expression of Interest in response to this document, will be deemed to acknowledge and accept that in respect of the information set out in this Request for Expressions of Interest and any other information. 1. The Respondent is aware that the Information is not guaranteed with respect to accuracy or completeness and that NSW Trustee and Guardian accepts no responsibility for the Information or any Interpretation or reliance placed on the Information by a Respondent; 2. The Respondent is aware that neither NSW Trustee and Guardian nor any of its employees, officers or agents is liable for loss of any kind including damages, costs, interests, loss of profits or special loss or damage arising from any inaccuracy or incompleteness in the Information; 3. The Respondent has made its own independent evaluation of the suitability of the Information for the purpose of submitting its Expression of Interest prior to using the Information; 4. No representation or warranty (expressed or implied) has been made by NSW Trustee and Guardian. (or anyone on its behalf) to the applicant that:
a. The Information is suitable for the purpose of submitting its Expression of Interest; or b. Reasonable care has been taken in preparing the Information.
This EOI is an invitation to Register Interests and must not be interpreted, or relied upon, whether by expression or implication, or as creating any form of contractual obligation, or rights based upon similar legal or equitable grounds.
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Expressions of Interest Response Section
Cover Sheet. The Service Providers are to clearly indicate the services which are applicable to their response. Please circle (O) the applicable trades / services. Home Building Licence Non - Licence Builders Building Consultants Painters Pre Purchase Building Inspections Kitchen, Bathroom & laundry Renovators Pest Inspectors (incl pre purchase) Plumbers, Drainage & Gas Fitters Strata pre purchase inspections Hot Water Installers Flyscreens & Window Accessories Roofers – Tile Forensic Cleaning Roof Plumbing – Metal Contents Removal, Sale, Storage Minor Maintenance (<$5k) Yard Maintenance Contractors Landscapers Large Yard (Vegetation & Rubbish) Wall & Floor Tilers Pest Services Glaziers Certifiers (Building) Fencing Tree Loppers Installation of Security Grilles & Equipment Cleaners Swimming Pool Builders Swimming Pool Repairs & Servicing Underpinning/Piering Air Conditioning & Refrigeration› Electricians Scopers
16. Appendix A: Application Form and Declaration Providers are required to provide evidence of their legal entity either by providing a copy of an official document such as company registration and names of office bearers issued by the Australian Securities Commission or a statement confirming the legal entity signed by a practicing solicitor.
Respondent’s Legal Name: Respondent’s Business or Trading Name: Australian Business Number (A.B.N.) : Australian Company Number (A.C.N.): Date when Business Commenced Operation: Legal entity of above for Registration/contracting (tick as applicable)
Sole trader □ Partnership □ Company □ Holding co. □ Subsidiary Co. □ Business Address:
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Postal Address: Contact Person: Contact Number(s): Bus: Mob: After hours : Facsimile Number: Email Address: Preferred Method of Delivery of Information: □Email □Fax □Post Membership Details of Industry Association(s) (if Applicable): License No. & Type:
Copy of license attached □ Copy of registration documentation □
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ADDITIONAL DETAILS (to be completed by all Providers):
Have you, or any business you have been managing, ever failed to complete a scope of works?
Yes/No (If yes, please provide details)
Have you, or any business you have been managing, been declared bankrupt or been subject to repossession proceedings over the past seven years?
Yes/No (If yes, please provide details)
Are there any judgment debts or court orders against the Respondent?
Yes/No (If yes, please provide details)
Do you, your employees and sub-contractors have a current police check?
If no to the above question, are you, your employees and sub-contractors willing to apply for a police check prior to any acceptance of any works being undertaken?
DECLARATION BY RESPONDENT I/ We have noted and accept all the conditions contained in this Request for Expressions of Interest. I/ We hereby submit the Expression of Interest with NSW Trustee and Guardian and declare that to the best of my/our knowledge the particulars shown herein are true and correct.
Date:
Signed for the Respondent by:
Name (IN BLOCK LETTERS):
Position:
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17. Appendix B: Response Statement Providers are required to demonstrate, to NSW Trustee and Guardian’s satisfaction, that they have the capability, capacity, experience and financial standing to manage and deliver the services and goods required. Providers must provide response statements to the evaluation criteria that are identified in clause 13 of the EOI, which incorporate as a minimum the following information: Mandatory Requirement – Evidence of Insurance Policies and validity dates attached. Insurer Policy
No Insured Amount
Expiry Date
Exclusions, if any
Public Liability Insurance
Public and Product Liability Insurance not less than $10 000 000 for each individual occurrence and with respect to product liability.
Professional Indemnity [delete row if not applicable]
Workers’ Compensation
Insurance covering loss and damage to goods in the Service Providers care, custody and Facilities.
Evaluation Criteria 1: Demonstrated suitability, capability and capacity to undertake the works required. 1.1 Use of Subcontractors Providers are to nominate the work proposed to be subcontracted and provide details of the intended businesses to do this work, including landscape design and construction. Details are to include the qualifications, licenses and experience of the personnel intended to undertake the NSW Trustee and Guardian projects.
1.2 Quality Management / Professional Memberships
Providers are to provide details, and where possible examples, of their quality management system, the status of implementation. Providers are to identify the professional
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institutions and any professional memberships they are registered with. 1.3 WHS and Industrial Relations Policies
Providers are to provide details of WHS Policy.
Evaluation Criteria 2: Demonstrated ability to complete works to agreed quality standards 2.1 Contract Administration
If applicable, Providers should provide details, and where possible examples, of their approach to contract administration, including quality control, risk management, cost control, programming, timely completion and standards compliance. Providers are to acknowledge they have read, understood and agree with the draft terms and conditions provided with the EOI kit
2.2 Defect and Warranty Performance
Providers should provide details, and where possible examples, of their approach to defect and warranty performance during warranty periods and contract finalisation.
2.3 Referees
Providers are to nominate and provide contact details of at least three referees who can verify or provide information from a client perspective regarding previous experience, quality of work, performance and timely completion of projects/works of a similar nature.
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Evaluation Criteria 3: Schedule of Rates Financial Capacity and Capability Providers are required to submit a schedule of rates which identifies normal hours hourly rates, after-hours hourly rates, any travel costs, response times and all level of labor costs. Please complete your rates for any relevant activities/ labor categories
Schedule of Rates –
Unit of measure
Normal Hours
7.30am – 6 pm
Mon- Fri
After Hours
6pm– 7.30am
Sat, Sun , Public Holidays
Emergency call out fees
Rate $ plus $ -GST Total rate
Travel costs and other:
Activity Category
Travel charge
Other charges please specify
$ cost
plus $ -GST
Total cost
Material Costs
eg: cost + 2%
Note: The above information will be used to assist our staff in pre qualifying Providers prior to RFT/RFQ and will not be publicised
Prices remain firm for the first twelve (12) months and are then variable in accordance with the price variation formula given in Schedule 2.
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The Respondent is to indicate its preferred method of payment:
(please tick the preferred method)
Electronic Funds Transfer
NSWTG preferred method of payment
Cheque
The respondent acknowledges that payment terms will be 30 days from a correctly rendered invoice.
Additional Information Providers should provide any additional information they consider relevant in support of their Expression of Interest.
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18. Appendix C Compliance to Industry Standards: Fair Trading home building contracts
For all types and sizes of residential building work, Fair Trading home building contracts will be used. There are two contracts available, downloadable for FREE in PDF format.
http://www.fairtrading.nsw.gov.au/Tradespeople/Building_industry_essentials/Home_building_contracts.html#Contract_essentials
Please note:
Fair Trading home building contracts are in savable and fileable PDF format. This means they can be completed on screen and printed, then saved on your computer for re-use at another time. All you need to do to re-use is update the details that have changed.
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19. Appendix D Geographical locations: Zone
Colour Please click on link below
to view the relevant suburbs
within the zones/ regions
Description of Area (Note: The areas below include but are not limited to the following Council
boundaries.)
Please circle (O) the applicable regions where services are proposed to be provided.
Ice Northern
Region Armidale, Glen Innes Severn, Gunnedah Shire, Guyra Shire, Gwydir Shire, Inverell Shire, Liverpool Plains Shire, Moree Plains Shire, Narrabri Shire, Tamworth Regional, Tenterfield Shire, Uralla Shire, Walcha
Blue
Central West Bathurst Regional, Bland Shire, Blayney Shire, Cabonne, Cowra Shire, Forbes Shire, Lachlan Shire, City of Lithgow, Mid-Western Regional, Oberon, Orange City, Parkes Shire, Weddin Shire
Salmon
Far West Broken Hill City, Central Darling Shire, Unincorporated Far West
Purple Hunter Cessnock City, dungog Shire, Gloucester Shire, Great Lakes, Lake Macquarie City, Maitland City, Muswellbrook Shire, Newcastle City, Port Stephens, Singleton, Upper hunter Shire
Green Illawarra Municipality of Kiama, Shellharbour City, Shoalhaven City, Wingecarribee Shire, Wollongong City
Olive Murrumbidgee Carrathool Shire, Coolamon Shire, Cootamundra Shire, Griffith City, Gundagai Shire, Hay Shire, Junee Shire, Leeton Shire, Lockhart Shire, Murrumbidgee Shire, Narrandera Shire, Temora Shire, Wagga Wagga Shire
Orange Murray Albury City. Balranald Shire, Berrigan Shire, Conargo Shire, Corowa Shire, Deniliquin, Greater Hume Shire, Jerilderie Shire, Murray Shire, Tumbarumba Shire, Urana Shire, The Council of the Shire of Wakool, Wentworth Shire
Green Mid - North Coast
Bellingen Shire, Clarence Valley, Coffs Harbour City, Greater Taree City, Port Macquarie-Hastings, Kempsey Shire, Nambucca Shire
Light Green
Richmond - Tweed
Ballina Shire, Byron Shire, Kyogle, Lismore City, Richmond Valley, Tweed Shire
Skin South Eastern Bega Valley Shire, Bombala, Boorowa, Cooma-Monaro Shire, Eurobodalla Shire, Goulburn Mulwaree, Harden Shire, Palerang, Queanbeyan City, Snowy River Shire, Tumut Shire, Upper Lachlan Shire, Yass Valley, Young Shire
Mustard North Western Bogan Shire, Bourke Shire, Brewarrina Shire, Cobar Shire, Coonamble Shire, Dubbo City, Gilgandra Shire, Narromine Shire, Walgett Shire, Warren Shire, Warrumbungle Shire, Wellington Shire
Yellow Sydney Inner Ashfield, Council of the city of Botany Bay, Burwood, City of Canada Bay, Canterbury City, Municipality of Hunters Hill, Hurstville City, Kogarah City, Lane Cove Municipal, Leichhardt Municipal, Manly, Marrickville, Mosman Municipal, North Sydney, Randwick, Rockdale, Strathfield, City of Sydney, Waverley, Willoughby City, Woollahra
Beige Sydney Outer Auburn, Bankstown, The Hills Shire, Blacktown City, Fairfield City, Holroyd City, Hornsby Shire, Ku-Ring-gai, Liverpool, Parramatta, Penrith, Pittwater, Ryde, Sutherland, Warringah
Grey Sydney Surrounds
Blue Mountains City, Gosford City, Hawkesbury City, Wollondilly Shire, Wyong Shire
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20. Appendix E Conflict of interest Form:
This Declaration is made on the […] day of [ ] 20[……],
By: [ ] of [ ] in New South Wales,
Australia.
This declaration acknowledges my obligations to identify and declare any conflict of interest in relation to services provided to NSW Trustee and Guardian. In this declaration: “family member” means spouse, de facto spouse, same sex partner, siblings, parents and children “Service provider” is an external individual or company engaged by NSW Trustee and Guardian to provide a service to NSW Trustee and Guardian or a client of NSW Trustee and Guardian”) of NSW Trustee and Guardian. “Conflict of interest” involves a conflict between personal interests of service provider and interests of NSW Trustee and Guardian or interests of the client of NSW Trustee and Guardian and includes actual conflict, potential conflicts and perceived conflicts, as such: An actual conflict of interest involves a real and defined conflict between the personal interests of the service provider and the interests of NSW Trustee and Guardian or interests of the client of NSW Trustee and Guardian. A potential conflict of interest involves situations where a conflict of interest could possibly arise. A perceived conflict of interest involves situations where a reasonable person could surmise that conflict of interest exists. Conflicts of interest are to be declared to NSW Trustee and Guardian as soon as the service provider becomes aware of them. Failure to declare can result in the service provider being removed from any panel arrangement managed by NSW Trustee and Guardian and any legal actions that may be deemed necessary in the circumstances. This declaration is to be signed by the individual where the service provider is an individual or by the owner/ director/executive officer where the service provider is a company. I Declare that:
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I affirm that, to the best of my knowledge and belief, after due enquiry as at the date of this declaration, that neither I, nor any member of my family, has any duties or interests that create or might reasonably be anticipated to create, conflict with my duties and interests in providing services to NSW Trustee and Guardian, except those disclosed in writing before I signed this declaration. I affirm that, to the best of my knowledge and belief, after due enquiry as at the date of this declaration, that no person in my employ, nor any member of their family, has any duties and interests that create or might reasonably be anticipated to create conflict with my duties and interests in providing services to NSW Trustee and Guardian, except those disclosed in writing before I signed this declaration. If an existing duty or interest develops in a way that could not reasonably have been anticipated, so that duty or interest creates, or might reasonably be anticipated to create, conflict with the provision of services for NSW Trustee and Guardian, then I will consult with NSW Trustee and Guardian to endeavor to devise arrangements so that the conflict of interest can be managed appropriately. This declaration is signed in the understanding that failure to declare any conflict of interest to NSW Trustee and Guardian can result in removal from service panel arrangements. Signed by me on the above date in the presence of - ……………………………………………………………………………………………………….. ……………………………………………………………………………………………………….. Witness Signature………………………………………………….……………………… Full Name …………………………………………………….………………………………. Address.…………………………………………………….…………………………………..