Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO)
ECHO.A - Emergency Management
A/4 Civil Protection Policy
GRANT
APPLICATIONFORMS
2018CALL FOR PROPOSALS
FOR
BUFFER CAPACITIES FOR ADDRESSING TEMPORARY SHORTCOMINGS IN EXTRAORDINARY DISASTERS
FORMS A and T
NOTE:
Financial Forms are in a separate file.
In a multi-beneficiary grant, it is the responsibility of the Coordinator to collect and submit all the applicable forms on behalf of each beneficiary.
FORMS A:
Summary and Administrative Information
Form A0
/ EUROPEAN COMMISSIONDirectorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO)
ECHO.A - Emergency Management
A/4 Civil Protection Policy
Brussels,
DG ECHO, Unit A4
Name of Coordinator:
Contact person:
Postal Address:
Mobile number:
E-mail:
ACKNOWLEDGEMENT OF RECEIPT
Title of the project: ......
Correspondence No. of the project[1]
Sir, Madam,
I acknowledge receipt of your proposal for which I thank you.
Your proposal will be examined by our services, with respect to its eligibility. Those proposals declared eligible will then undergo an evaluation procedure by the Commission.
I will let you know the final decision, as soon as it has been taken.
Yours faithfully,
Form A1- required for mono-beneficiary and multi-beneficiary grants
PROJECT
Project title (max. 60characters):………………………………………………………………………………………......
Projectacronym(max.25characters):
………………………………………………………………………………..
The project will be implemented in the following country (ies): …………………………………………………………………………………………………………………
Starting date: ...... Ending date: ...... Duration in months : ……….
COORDINATOR and BENEFICIARIES
Name of beneficiary / coordinator (CO): ......
Below information required only in case of multi-beneficiary grant
Name of beneficiary (BE1): …………………………………………………………………………………
Name of beneficiary (BE2): …………………………………………………………………………………
Name of beneficiary (BE3): …………………………………………………………………………………
(Continue as necessary)
CO-FINANCIER
Legal name and country of co-financier (same as in Form A6):
affiliated entity
Legal name of the affiliated entity (same as in Forms A4 or A5) and the beneficiary that it is affiliated to:
(Continue as necessary)
Project Budget and REQuested EC funding
Total project eligible cost: ……………. EUR
EC financial contribution requested:……………. EUR
Form A2 - required for mono-beneficiary and multi-beneficiary grants (to be completed by the Coordinator and all Beneficiaries)
Comments [in grey italics in square brackets] to be deleted and/or replaced as appropriate by the entity signing the declaration.
Declaration on honour
Ref: action [insert name/reference];
[insert reference to the call for proposals if applicable]
The undersigned [insert the name of the person signing this form], representing:
(only for legal persons) the following entity:Full official name:
Official legal form:
Statutory registration number:
Full official address:
VAT registration number:
declares that the entity:
is eligible in accordance with the criteria set out in the specific call for proposals;has the required financial and operational capacity as set out in the specific call for proposals[2];
has not received any other Union funding to carry out the actionsubject of this grant application and commits to declare immediately to the Commission/ the Agency any other such Union funding it would receive until the end of the action.
If any of the above requirements is not satisfied, please indicatein annex to this declaration which and the name of the concerned entity with a brief explanation.
I – Situations of exclusion concerning the entity(ies)
declares that the entityis notin one of the following situations. If yes, please indicate in annex to this declaration which situation with a brief explanation.a)it is bankrupt, subject to insolvency or winding up procedures,its assets are being administered by a liquidator or by a court, it is in an arrangement with creditors, its business activities are suspendedor it is in any analogous situation arising from a similar procedure provided for under national legislation or regulations;
b)it has been established by a final judgement or a final administrative decision that it is in breach of its obligations relating to the payment oftaxes or social security contributions in accordance with the law of the country in which it is established, with those of the country in which the authorising officeris located or those of the country of the performance of the contract;
c)it has been established by a final judgement or a final administrative decision that it is guilty of grave professional misconductby having violated applicable laws or regulations or ethical standards of the profession to which the entity belongs, or by having engaged in any wrongful conduct which has an impact on its professional credibity where such conduct denotes wrongful intent or gross negligence, including, in particular, any of the following:
- (i) fraudulently or negligently misrepresenting information required for the verification of the absence of grounds for exclusion or the fulfilment of selection criteria or in the performance of a contract,a grant agreement or a grant decision;
- (ii) entering into agreement with other persons with the aim of distorting competition;
- (iii) violating intellectual property rights;
- (iv) attempting to influence the decision-making process of the Commission/ the Agency during the award procedure;
- (v) attempting to obtain confidential information that may confer upon it undue advantages in the award procedure;
d)it has been established by a final judgement that it is guilty of the following:
- (i) fraud, within the meaning of Article 1 of the Convention on the protection of the European Communities' financial interests, drawn up by the Council Act of 26 July 1995;
- (ii) corruption, as defined in Article 3 of the Convention on the fight against corruption involving officials of the European Communities or officials of EU Member States, drawn up by the Council Act of 26 May 1997, and in Article 2(1) of Council Framework Decision 2003/568/JHA, as well as corruption as defined in the legal provisions of the country where the authorising officer is located, the country in which the entity is established or the country of the performance of the contract;
- (iii) participation in a criminal organisation, as defined in Article 2 of Council Framework Decision 2008/841/JHA;
- (iv)money laundering or terrorist financing,as defined in Article 1 of Directive 2005/60/EC of the European Parliament and of the Council;
- (v) terrorist-related offences or offences linked to terrorist activities, as defined in Articles 1 and 3 of Council Framework Decision 2002/475/JHA, respectively, or inciting, aiding, abetting or attempting to commit such offences, as referred to in Article 4 of that Decision;
- (vi) child labour or other forms of trafficking in human beingsas defined in Article 2 of Directive 2011/36/EU of the European Parliament and of the Council;
e)it has shown significant deficiencies in complying with the main obligations in the performance of a contract, a grant agreement or a grant decision financed by the Union’s budget, which has led to its early termination or to the application of liquidated damages or other contractual penalties, or which has been discovered following checks, audits or investigations by an Authorising Officer, OLAF or the Court of Auditors;
f)it has been established by a final judgment or final administrative decision that it has committed an irregularity within the meaning of Article 1(2) of Council Regulation (EC, Euratom) No 2988/95;
g)for the situations of grave professional misconduct, fraud, corruption, other criminal offences, significant deficiencies in the performance of the contract or irregularity, it is subject to:
- facts established in the context of audits or investigations carried out by the Court of Auditors, OLAF or internal audit, or any other check, audit or control performed under the responsibility of an authorising officerof an EU institution, of a European office or of an EU agency or body;
- non-final administrative decisions which may include disciplinary measures taken by the competent supervisory body responsible for the verification of the application of standards of professional ethics;
- decisions of the ECB, the EIB, the European Investment Fund or international organisations;
- decisions of the Commission relating to the infringement of the Union's competition rules or of a national competent authority relating to the infringement of Union or national competition law;
- decisions of exclusion by an authorising officerof an EU institution, of a European office or of an EU agency or body.
II – Situations of exclusion concerning natural persons with power of representation, decision-making or control over the entity(ies)
This section applies only to declarations by legal persons, with the exception of Member States and local authorities
declares that, for the entity subject to this declaration, (a) natural person(s)who is/are member(s) of the administrative, management or supervisory body(ies) or who has/havepowers of representation, decision or control(this covers company directors, members of management or supervisory bodies, and cases where one person holds a majority of shares)is/are notin one of the following situations. If yes, please indicate in annex to this declaration which situation and the name(s) of the concerned person(s) and entity(ies) with a brief explanation.- - situation (c) above (grave professional misconduct)
- - situation (d) above (fraud, corruption or other criminal offence)
- - situation (e) above (significant deficiencies in performance of a contract)
- - situation (f) above (irregularity)
III – Situations of exclusion concerning natural or legal persons assuming unlimited liability for the debts of the entity(ies)
This section applies only to declarations that include an entityfor which a natural or legal personassumes unlimited liability fordebts
declares that(a) natural or legal person(s)that assume(s) unlimited liability for the debts of the entity(ies) subject to this declarationis/are notin one of the following situations.If yes, please indicate in annex to this declaration which situation and the name(s) of the concerned person(s) and entity(ies) with a brief explanation .- - situation (a) above (bankruptcy)
- - situation (b) above (breach in payment of taxes or social security contributions)
IV –Remedial measures
If for the entity subject to this declaration it has been declared that it is in one of the situations of exclusion listed above, an annex to this declaration must indicate the measures the entity has taken to remedy the exclusion situation, thus demonstrating its reliability. This may include e.g. technical, organisational and personnel measures to prevent further occurrence, compensation of damage or payment of fines. The annex must include relevant documentary evidence which illustrates the remedial measures taken. Remedial measures cannot be proposed for situations referred in point (d).
V –Evidence upon request
The Commission may requestthe entity subject to this declaration to provide information and the applicable evidence on any person thatis member of an administrative, management or supervisory body (persons with powers of representation, decision or control with regard to that entity).
The Commission may request the entity subject to this declaration toprovide the applicable evidence concerning the entity itself and / or concerning the natural or legal persons which assume unlimited liability for the debts of the entity.
Evidence may be requested as follows:
For situations described in (a), (c), (d) or (f), production of a recent extract from the judicial record is required or, failing that, an equivalent document recently issued by a judicial or administrative authority in the country of establishment of the entity showing that those requirements are satisfied.
For the situation described in point (a) or (b), production of recent certificates 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 entity is liable, including for example, VAT, income tax (natural persons only), company tax (legal persons only) and social security contributions. Where any document described above is not issued in the country concerned, it may be replaced by a sworn statement made before a judicial authority or notary or, failing that, a solemn statement made before an administrative authority or a qualified professional body in its country of establishment.
If an entity has already submitted such evidence for the purpose of another procedure and provided that the submitted documents are still valid and that the time that has elapsed since the issuing date of the documents does not exceed one year, the entity shall declare on its honour that the documentary evidence has already been provided and confirm that no changes have occurred in its situation.
If selected to be awarded a grant, the entitysubject to this declaration accept the terms and conditions laid down in the grant agreement.
The entity subject to this declaration may be subject to rejection from this procedure and to administrative sanctions (exclusion or financial penalty) if any of the declarations or information provided as a condition for participating in this procedure prove to be false.
Full nameDateSignature
Form A3– required for multi-beneficiary grants only
Partnership statement (to be signed by the Coordinator and all Beneficiaries)
A partnership is a relationship, involving shared responsibilities,between two or more entities for the purpose of implementing an Action funded by the European Union, represented by the European Commission. To ensure that the Action runs smoothly, the Commission thus requires the below outlined good partnership principles to be acknowledged and upheld.
I, [LAST NAME, Name of the signatory of thestatement], on behalf of
[Full official name of the entity]
[Official legal form of the entity]
[Full official address of the entity]
[VAT registration number of the entity]
declare to have read and approved the content of the proposal entitled [insert title of the proposal] submitted for funding to the Commission and I undertake to comply with the following principles of good partnership:
- The coordinator and the beneficiaries have read the Guide for Applicants and theGrant Application Forms andunderstandthe purposes and expected results of the Call for proposals. Furthermore, the coordinator and the beneficiaries understand their role in the Action before the submission of the application to the European Commission. They commit to comply with the relevant eligibility criteria, as defined in the Call for proposals.
- The coordinator and the beneficiaries have read the applicable Grant Agreement and understand their respective obligations under the Grant Agreement. The beneficiaries authorise the coordinator to sign the Grant Agreement with the Commission on their behalf and to represent them in all dealings with the Commission in the context of the implementation of the Action.
- The coordinator consults other beneficiaries regularly concerning the different aspects of the implementation of the Action and keeps them fully informed.
- The beneficiaries receive copies of reports - narrative and financial –prepared for and submitted to the Commission.
- Any requests for amendments to the agreement (e.g. changes to the activities presented in Annex I to the Agreement, beneficiaries etc.) are agreed by the coordinator and beneficiaries prior to submission to the Commission. Where no such agreement can be reached and the request is nonetheless submitted to the Commission the absence of agreement is to be mentioned in the request.
Name
Position
Title of the Project
Date and place
Signature
Form A4– required for mono-beneficiary and multi-beneficiary grants
COORDINATOR PROFILE
Coordinator Profile InformationShort Name / Participant ref. / CO
Legal information on the Coordinator
Legal Name * / Legal Status
VAT No / Public
Private
Natural person
Legal Registration No
Registration Date
* The legal name is the name under which the participant(s) is/are registered in the official trade register / International organisation
Legal address of the Coordinator
Street Name and No / PO Box
Post Code / Town/City
Country Code / Country Name
Coordinator contact person information
Title / Function
Surname / First Name
Department / Service Name
Street Name and No / PO Box
Post Code / Town/City
Country
Telephone No / Fax No
E-mail / Website
Coordinator details
Number of employees
Number of employees in department conducting project
Is Your Organisation independent (Yes or No)
If No, please indicate legal name(s) of owner(s) who own 25 % or more
Is there an entity affiliated to you taking part in the project? (Yes or No)[3]
If Yes, please indicate the name(s) of the affiliated entity (ies) and the nature of the structural link.[4]
Brief description of the structure and the activities of the Coordinator
Form A5- required for multi-beneficiary grants only
BENEFICIARY PROFILE (one separate form per Beneficiary)
Beneficiary Profile InformationShort Name / Participant ref. / BE…
Legal information on the Beneficiary
Legal Name* / Legal Status
VAT No / Public
Private
Natural person
Legal Registration No
Registration Date
* The legal name is the name under which the participant(s) is/are registered in the official trade register / International organisation
Legal address of the Beneficiary
Street Name and No / PO Box
Post Code / Town/City
Country Code / Country Name
Beneficiary contact person information
Title / Function
Surname / First Name
Department / Service Name
Street Name and No / PO Box
Post Code / Town/City
Country
Telephone No / Fax No
E-mail / Website
Beneficiary details
Annual turnover / Last Financial Year
Number of employees
Number of employees in department conducting project
Is Your Organisation independent (Yes or No)
If No, please indicate legal name(s) of owner(s) who own 25 % or more
Is there an entity affiliated to you taking part in the project? (Yes or No)[5]
If Yes, please indicate the name(s) of the affiliated entity(ies) and the nature of the structural link[6]
Brief description of the structure and the activities of the Beneficiary
Form A6
CO-FINANCIER PROFILE AND COMMITMENT (one separate form per each co-financier)*
Legal Name and full address on the co-financierFinancial commitment
We will contribute the following amount to the project: / ….. €
Status of the financial commitment
Stamp and signature of the authorised person
Name and status of the authorised person (obligatory):
Date of the signature
(obligatory):
Signature (obligatory):
* If the project includes co-financers other than the European Commission, this form is compulsory. Complete one form per co-financer (A6/1, A6/2, A6/3, etc.)
Remember that the amounts in Form(s) A6 must be consistent with the amounts indicated in the financial forms F0 and F1.
Form A7– required for mono-beneficiary and multi-beneficiary grants
OTHER PROPOSALS SUBMITTED FOR EUROPEAN UNION FUNDING
Please answer each of the following questions:
Have you or any of the beneficiaries already benefited from previous co-financing under any EU civil protection financial instruments or programmes? (Title, year, amount of the co-financing and duration)
Have you or any of the beneficiaries already benefited from previous European Union financing (grants, procurements or loans) for activities that may relate to the present proposal (e.g. an RTD project preceding the present proposal)? (title, year, amount of financing and duration)