Annex Vfor Lot 3

Financial offer form

Call for tender n°Chafea/2015/Health/05concerning Multiple Framework Contracts with reopening of competition for the "Scripting, planning, conduction and evaluation of exercises, training and assessment implementing the Decision no 1082/2013/EU on serious cross-borderthreats to health"

Name of the tenderer: ……………………………………………….

1.1.Scenario drafting for an event
You are requested to indicate, for each activity, the price for the drafting of the scenario of a one day activity in accordance with the expectations described in the tender specifications for each activity. Attention, it is a fixed unit price. / You are requested to indicate, for each activity, the price for the drafting of the scenario of a 2 days activity in accordance with the expectations described in the tender specifications for each activity. Attention, it is a fixed unit price.
1. Training and exchange of experts modules / => -€ / => -€
2. Online training course / => -€ / => -€
1.2. Preparation and organisation of the event
You are requested to indicate, for each activity, the price for the preparation and organisation of a one day activity, including the organisation of the travel and hosting of the participants and your staff as appropriate in accordance with the expectations described in the tender specifications for each activity. Attention, it is a fixed unit price. / You are requested to indicate, for each activity, the price for the preparation and organisation of a two days activity, including the organisation of the travel and hosting of the participants and your staff as appropriate in accordance with the expectations described in the tender specifications for each activity. Attention, it is a fixed unit price.
1. Training and exchange of experts modules / => -€ / => -€
2. Online training course / => -€ / => €
1.3. Evaluation of the event
You are requested to indicate, for each activity, the price for the evaluation of a one dayactivity. The expectations for each event are described in the tender specifications for each activity. Attention, it is a fixed unit price. / You are requested to indicate, for each activity, the price for the evaluation of a two daysactivity. The expectations for each event are described in the tender specifications for each activity. Attention, it is a fixed unit price.
1. Training and exchange of experts modules / => -€ / => -€
2. Online training course / => -€ / => -€
1.4. Operational costs of
[E.g. production cost – material, USB, audio or video tape, DVD, CD-ROM, satellite TV, publication, reporting, overheads like telephone, fax, paper, envelopes, photocopies]
You are requested to indicate, for each activity, the price for the operational costs of a one day activity. The expectations for each event are described under in the tender specifications for each activity. Attention, it is a fixed unit price. / E.g. production cost – material, USB, audio or video tape, DVD, CD-ROM, satellite TV, publication, reporting, overheads like telephone, fax, paper, envelopes, photocopies]
You are requested to indicate, for each activity, the price for the operational costs of a one day activity. The expectations for each event are described under in the tender specifications for each activity. Attention, it is a fixed unit price.
one day event. / Including video recording / two days event / Including video recording
1. Training and exchange of experts modules / => -€ / => -€ / => -€ / => -€
2. Online training course / => -€ / => -€ / => -€ / => -€
1.5. Subtotals of all the above positions
Please provide in the table below the sums of the respective cells above for a one dayactivity. / .Please provide in the table below the sums of the respective cells above for a two daysactivity.
1. Training and exchange of experts modules / => -€ / => -€
2. Online training course / => -€ / => -€

1.6. Basis for the evaluation of the tender

The calculation of the total taken into account for the award of the contract will be as follows:

Use of the amounts indicated in table 1.5 above, and attribution of a weighting to each exercise setting:

In case of one day event / In case of two days event
1. Training and exchange of experts modules / 15 % of the amount indicated in table 1.5 / ………………….-€ / ………………-.€
2. Online training course / 5 % of the amount indicated in table 1.5 / ………………….-€ / ……………….-€
Overall total taken into account for the award of the contract / ………………….-€ / ………………….-€
2. Travel and subsistence costs for the contractor’s staff for 1 meeting (to meet representatives of the Executive Agency and the Commission)
Please provide the travel and subsistence costs of 1 meeting to meet the representatives of the Executive Agency and the Commission. Please note that it will be considered as a ceiling per meeting for the reimbursement of the costs based on the invoices presented by the Contractor.
Destination / Travel expenses (flight, train) / Subsistence allowance / Total costs
CHAFEA Luxembourg/DG SANTELuxembourg /Brussels / ………-€ / ………-€ / ………………-€

Signature of the tenderer, function......

Full name in capitals......

Date