Annexure – A:

Participants Questionnaire: Stakeholder ConsultationWorkshop for Outsourcing of Laboratory Services Scheduled on 20thFebruary, 2015

/ Name of the Service Provider
/ Name of Contact person
/ Contact Details / Address:
Contact No.:
Tel:
Mob:
Fax:
E-mail:
/ Expected participation as Sole Bidder/ Prime Respondent / Consortium Partner
/ Experience (In years) of operating Laboratory / Pathology Centres in India /
  1. More than 1 Year
  2. More than 3 Year
  3. More than 5Year
  4. More than 10Year
  5. More than 15Year

/ Total Nos of Operational Laboratory / Pathology Centres in India /
  1. More than 5 Labs
  2. More than 10 Labs
  3. More than 15 Labs
  4. More than 20 Labs
  5. More than 25 Labs

/ Total Nos of NABL accredited Laboratory / Pathology Centres in India /
  1. More than 1
  2. More than 3
  3. More than 5
  4. More than 8
  5. More than 10

/ Total Nos of NABL accredited Laboratory / Pathology Centres in Uttar Pradesh /
  1. More than 1
  2. More than 3
  3. More than 5
  4. More than 8
  5. More than 10

/ Total Nos of Collection Centres in India /
  1. More than 10
  2. More than 50
  3. More than 100
  4. More than 200
  5. More than 500

/ Total Nos of Collection Centres in Uttar Pradesh /
  1. More than 10
  2. More than 30
  3. More than 50
  4. More than 75
  5. More than 100

/ Work experience in Public Private Partnership for outsourcing Laboratory Services / If yes, please mention below no of years:
  1. More than 1 Year
  2. More than 3 Year
  3. More than 5 Year

Please mention below total no of projects under PPP:
  1. 1
  2. More than 1
  3. More than 3
  4. More than 5

/ Total turnover of last five financial years /
  1. 2009-2010 –
  2. 2010-2011 –
  3. 2011-2012 –
  4. 2012-2013 –
  5. 2013-2014 –

Note: Kindly fill and attach this annexure with complete details along with your confirmation for participation in the Workshop through e-mail on or