Bristol Ageing Better

BRISTOL AGEING BETTER

WELLBEING PROJECT

PILOT PHASE

TENDER SUBMISSION FORM

Please familiarise yourself with the information contained in the Invitation to Tender before completing this form.

Name of Provider

Please return this form and any supporting documents by e-mail to

The deadline for submissions is 12pmon Monday 15th August 2016. Bidsreceived after the deadline may not be considered.Please contact BAB if you do not receive confirmation of receipt within 2 working days.

Please use the box below to list any supporting documents attached to or embedded within your application:

Document Name / No. of Pages in Document

SECTION A

Q1 ORGANISATIONAL DETAILS

1.1 / Name of the Organisation submitting the bid
1.2 / Contact name:
1.3 / Address:
1.4 / Telephone number:
1.5 / Email address:
1.7 / Date of registration or incorporation:
1.8 / Company Registration number (if
applicable):
1.9 / Registered charity number (if applicable)

Q 2FINANCIAL CAPABILITY TO DELIVER THE SERVICE

2.1 Please provide the name and address of your banker:

2.2 The most recent audited accounts for my organisation are available on the Charity Commission website:

Yes / No (please delete as appropriate)

If No is selected, please include the following in your application:

a)A copy of the most recent audited accounts for your organisation for the most recent full year of service delivery or

If none of the above is available, please state the reason below:

Q3LEGAL AND POLICY COMPLIANCE TO DELIVER THE SERVICE

3.1Please confirm below if your organisation has in place, or can comply with the following. BAB may ask to see some or all of the following from selected delivery partners before issuing a contract:

Yes/No
Constitution/ Articles of Association/other Governance document for the organisation
Vulnerable Adults Safeguarding Policy
Health & Safety Policy
Equalities Policy
VOLUNTEERS: Does your organisation have a Volunteers Policy?
USER ENGAGEMENT:Does your organisation have an Older People Involvement/Service User Participation Policy.
DATA PROTECTION:Does your organisation comply with the Data Protection Act 1998 and any other relevant legislation related to the storage of and access to information?
INSURANCE: Can you confirm that the insurance levels listed below will be in place before a contract for this service is signed

Employers Liability being not less than £5 million
Public Liability being not less than £5 million

DBS:Can you confirm that all staff and volunteers involved in the delivery of the service in roles which are eligible for DBS checks hold up to date enhanced DBS certificates?
COMPLAINTS:Does your organisation have a Complaints Policy?

If you have answered NO to any of the above please provide an explanation in the box below.

4REFERENCES

Please provide the following information for 2 referees. One of the referees must be a funder and must be independent of your organisation. (Note: Please ensure that your referees are available to provide a prompt response after the closing date for the bid).

Name / Job Title and Organisation / E-mail / Telephone Number / Relationship to your organisation
1.
2.

5 PROJECT PARTNERS

Please identify below any intended partners for this project:

Name of Organisation / Description of Organisation / Name and email of main contact / Proposed role in project delivery
1.
2.

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SECTION B: QUESTIONNAIRE

Please type your response to each question in the box below, not exceeding the word count. In the case of partnership bids, it will be the lead provider who will complete the questionnaire making the contribution of partners clear, with regard to each question.
All responses will be scored using the evaluation weighting listed with each individual question and in accordance with the evaluation model in Appendix 2.
Please ensure that the declaration at the end of the questionnaire is completed.

A Quality (80%)

Q1: Please provide a description of your organisation and experience of providing wellbeing services for older people.
Weighting:5% Word limit:200 Words.
Q2: Please describe your proposed pilot project including: details of solution-focused intervention, numbers of beneficiaries, number of sessions, duration of intervention, key features, other partners (if applicable) with description of the partner organisation, how the pilot might be extended in the future and summary action plan.
Weighting: 40% Word limit: 800 Words.
Q4: Please describe how older people have / will be involved in the design and delivery of this service.
Weighting: 10% Word limit: 200 Words.
Q5: Please provide an assessment of key risks to delivery and how you propose to mitigate these
Weighting: 10% Word limit: 200 Words.

B Best Value (20%)

Q6:Please give a breakdown of the costs of your service in the budget pro forma provided. Any additional value which your organisations or named partners can contribute to the total costs of the service (e.g. in terms of voluntary activity, in kind contribution or match funding) should be included where indicated.
Weighting: 20%

Wellbeing Pilot Project

Budget Pro-forma

Please note that the maximum available budget for this service is £15,000.Your budget proposal must be submitted on this pro-forma and in the format set out below. You may add explanatory notes if you wish.

Budget Items (add additional rows as required) / 2016/2017
Direct Project Costs (see Note 1)
TOTAL ALL DIRECT PROJECT COSTS
Indirect Project Costs (see Note 2)
TOTAL ALL INDIRECT PROJECT COSTS
TOTAL SERVICE COSTS
Additional Value contribution (see Note 3)
Development Support Fund (up to 0.5% of total contract value – see Appendix 1)
TOTAL BID COST

Note 1: Direct costsare specific costs relating directly to the delivery of servicesunder the funded project. (e.g. salary, transport and travel, premises, running costs, supplies and services, consultation and service access)

Note 2: Indirect costsare apportioned for the service from the overhead costs of the organisation as a whole. These could, for example, include a proportionate share of premises and office costs, management costs, management committee costs, professional fees. This is to enable all providers to recover the full cost of delivering the service

Note 3:Additional Value: If you are able to bring any additional value to this service please indicate the total value of the contribution for each year and subtract this from total service cost for each year to calculate the cost of your bid. Please provide an explanation in the box below of how the contribution has been calculated. These must be secured.

I certify that the information supplied is accurate to the best of my knowledge. Furthermore should my bid be successful I am able to abide by the conditions set out in the BAB Delivery Partner Contract.

Printed Name*:
BID SUBMISSION FORM DECLARATION
Name of Organisation /Lead Partner
Job title or position in organisation :
Date:

* Please type the name of the appropriate signatory and e mail this form to . A handwritten signature is not required.

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