ARBP PC01 GL01 TL02 Request for Proposal Web viewAnswers will be posted in the same location as the...

Request for Proposal (RFP)Subject RFP #: Field/217762/Data Quality Assessment/FFP-2021

RFP Issue Date: March 24, 2021

Terms of Reference / Specifications: Data collection services

ProjectData.FI

The Company Palladium International, LLC

Country of Performance Nigeria

Closing Date and Time April 1, 5pm, Abuja time

Contact Person Joshua Segalewitz, Project Delivery Associate, Data.FI/Nigeria

Details for Submission Submissions should be emailed to:

Joshua Segalewitz, [email protected]

Palladium/Data.FI is seeking proposals from qualified organizations (applicants) interested in providing the services as described in the attached solicitation. Palladium/Data.FI plans to negotiate the final details and award one contract to the selected organization on or before April 15, 2021, with completion of all activities and deliverables within 2 months of contract award. The procurement is subject to all applicable USAID and US Federal Government procurement regulations. Thank you for your interest in the above procurement. As implementer for the Project, Palladium invites you to submit a proposal for the terms of reference below. Your proposal must be valid for the Validity Period.

Please submit your proposal in accordance with the Details for Submission above by the Closing Date and Time. This RFP in no way obligates Palladium to award a contract nor does it commit Palladium to pay any costs incurred in the preparation and submission of a proposal. Palladium bears no responsibility for data errors resulting from transmission or conversion processes.

I look forward to your response. If you have any queries, please do not hesitate to Joshua Segalewitz ([email protected]) or myself at +234 803 705 2337 or by e-mail at [email protected].

Yours sincerely,

Dauda Sulaiman Dauda

Country Director, Data.FI/Nigeria

ARBP PC01 GL01 TL02 Request for ProposalRevised 18.09.19 1 / 19

mailto:[email protected]


Terms and conditions1. Proposal Conditions

By submitting a proposal, potential suppliers are bound by these terms and conditions. Potential suppliers must submit offers with all details provided in English and with prices quoted in a single currency.

2. Proposal Lodgement

The Company may grant extensions to the Closing Time at its discretion. The Company will not consider any quotes received after the Closing Time specified in the RFP unless the Company determines to do so otherwise at its sole discretion.

3. Evaluation

The Company may review all proposal to confirm compliance with this RFP and to determine the best proposal in the circumstances.

4. Alterations

The Company may decline to consider a proposal in which there are alterations, erasures, illegibility, ambiguity or incomplete details.

5. The Company’s Rights

The Company may, at its discretion, discontinue the RFP; decline to accept any proposal; terminate, extend or vary its selection process; decline to issue any contract; seek information or negotiate with any potential supplier that has not been invited to submit a proposal; satisfy its requirement separately from the RFP process; terminate negotiations at any time and commence negotiations with any other potential supplier; evaluate proposals as the Company sees appropriate (including with reference to information provided by the prospective supplier or from a third party); and negotiate with any one or more potential suppliers.

6. Amendments and Queries

The Company may amend, or clarify any aspect of the RFP prior to the RFP Closing Time by issuing an amendment to the RFP in the same manner as the original RFP was distributed. Such amendments or clarifications will, as far as is practicable be issued simultaneously to all parties.

Any queries regarding this RFP should be directed to the Contact Person identified on the cover page of this RFP.

7. Clarification

The Company may, at any time prior to execution of a contract, seek clarification or additional information from, and enter into discussions and negotiations with, any or all potential suppliers in relation to their proposals. In doing so, the Company will not allow any potential supplier to substantially tailor or amend their proposal.

8. Confidentiality

In their proposal, potential suppliers must identify any aspects of their proposal that they consider should be kept confidential, with reasons. Potential suppliers should note that the Company will only agree to treat information as confidential in cases that it considers appropriate. In the absence of such an agreement, potential suppliers acknowledge that the Company has the right to disclose the information contained in their proposal.

The potential supplier acknowledges that in the course of this RFP, it may become acquainted with or have access to the Company’s Confidential Information (including the existence and terms of this RFP and the TOR). It agrees to maintain the confidence of the Confidential Information and to prevent its unauthorised disclosure to any other person. If the potential supplier is required to disclose

Confidential Information due to a relevant law or legal proceedings, it will provide reasonable notice of such disclosure to the Company. The parties agree that this obligation applies during the RFP and after the completion of the process.

9. Alternatives

Potential suppliers may submit proposals for alternative methods of addressing the Company’s requirement described in the RFP where the option to do so was stated in the RFP or agreed in writing with the Company prior to the RFP Closing Time. Potential suppliers are responsible for providing a sufficient level of detail about the alternative solution to enable its evaluation.

10. Reference Material

If the RFP references any other materials including, but not limited to, reports, plans, drawings, samples or other reference material, the potential supplier is responsible for obtaining the referenced material and considering it in framing their proposal. And provide it to the Company upon request.

11. Price/Cost Basis

Prices or costs quoted must show the tax exclusive price, the tax component and the tax inclusive price.

The contract price, which must include any and all taxes, supplier charges and costs, will be the maximum price payable by the Company for the Goods and/or Services.

12. Financial information

If requested by the Company, potential suppliers must be able to demonstrate their financial stability and ability to remain viable as a provider of the Goods and/or Services over the term of any agreement.

If requested by the Company, the potential supplier must promptly provide the Company with such information or documentation as the Company reasonably requires in order to evaluate the potential supplier’s financial stability.

13. Referees

The Company reserves the right to contact the potential supplier’s referees, or any other person, directly and without notifying the potential supplier.

14. Conflict of interest

Potential suppliers must notify the Company immediately if any actual, potential or perceived conflict of interest arises (a perceived conflict of interest is one in which a reasonable person would think that the person’s judgement and/or actions are likely to be compromised, whether due to a financial or personal interest (including those of family members) in the procurement or the Company).

15. Inconsistencies

If there is inconsistency between any of the parts of the RFP the following order of precedence shall apply:

(a) these Terms and Conditions;

(b) the first page of this RFP; and

(c) the Schedule

so that the provision in the higher ranked document will prevail to the extent of the inconsistency.

16. Collusion and Unlawful Inducements

ARBP PC01 GL01 TL02 Request for Proposal 2 / 19

Potential suppliers and their officers, employees, agents and advisors must not engage in any collusive, anti-competitive conduct or any other similar conduct with any other potential supplier or person or quote any unlawful inducements in relation to their proposal or the RFP process.

Potential suppliers must disclose where proposals have been compiled with the assistance of current or former the Company employees (within the previous 9 months and who was substantially involved in the design, preparation, appraisal, review, and or daily management of this activity) and should note that this may exclude their proposal from consideration.

Potential suppliers warrant that they have not provided or offered any payment, gift, item, hospitality or any other benefit to the Company, its employees, consultants, agents, subcontractors (or any other person involved in the decision-making process relating to this RFP) which could give arise to a perception of bribery or corruption in relation to the RFP or any other dealings between the parties.

17. Jurisdiction

This RFP shall be subject to the laws of the District of Columbia, United States of America. The language of the arbitration will be English.

The Potential Supplier and the Company will use their best efforts to settle amicably any dispute, controversy, or claim arising out of, or relating to this RFP or the breach, termination, or invalidity thereof.

If no agreeable settlement can be found, any dispute, controversy, or claim arising out of or relating to this RFP or the breach, termination, or invalidity thereof, shall be settled by mediation through the American Arbitration Association by filing a request for mediation with the AAA and the other party. The Parties will be bound by any arbitration award rendered as a result of such arbitration as the final adjudication of any such dispute.


Schedule - Terms of Reference

PurposePalladium/Data.FI is conducting a data quality assessment of select organizations HIV implementing programs in Nigeria with funding support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/United States Agency for International Development (USAID). The specific objectives of the DQA are:

1. To verify that the quality of data reported are grounded in the components of data quality.

2. To ensure that managers can use these data generated to effectively direct available resources and to evaluate progress towards established goals.

3. To assess and identify potential challenges to data quality that the data management and reporting systems create at three levels:

a. The Activity’s Central M&E Unit.

b. The Intermediary Aggregation Level (State); and

c. The Service Delivery Sites (Healthcare facilities and One Stop Shops {OSS}).

4. To develop action plans to strengthen areas with identified weaknesses and gaps in the phases above.

The DQA will cover 5 General Population treatment partners and 3 Key Population treatment partners working across 16 states. The sampling frame is subject to change, but bidders should assume the following for the proposal development:

State Number of facilitiesAkwa Ibom 6Bauchi 3Cross River 6Lagos 4Niger 5Kano 2 Total 26

Palladium/Data.FI is seeking one contractor registered to operate in Nigeria to provide data collection services in support of this data quality assessment. The selected organization will work in close coordination with Palladium/Data.FI staff based in Nigeria and the USA. Palladium/Data.FI will act as a technical lead and be responsible for final deliverables to USAID.

Type of ContractFirm Fixed Price

Anticipated Contract TermApril 5-June 30, 2021

Company InformationPalladium is a global leader in the design, development and delivery of Positive Impact — the intentional creation of enduring social and economic value. We work with corporations, governments, foundations, investors, communities and civil society to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits.

ProjectData.FI is a five-year global project funded by the U.S. Agency for International Development (USAID) to support the HIV and COVID-19 response. Data.FI partners with programs to accelerate and sustain access ARBP PC01 GL01 TL02 Request for Proposal 4 / 19

to high-quality data to expedite HIV and COVID-19 epidemic control and maintenance. By improving global, regional, national, and community/local in-depth analyses of HIV and COVID-19 epidemiologic and programmatic data, Data.FI expedites program achievements to improve client services and attain and sustain control of the epidemics. Data.FI supports host country governments to enhance existing health information systems (HIS), informing management responses to gaps in programming and sustaining impact by supporting local partner transition.

Data.FI/Nigeria supports the HIV and TB (HAT) office of USAID Nigeria in performance management of its PEPFAR implementing partners (IPs), reporting, analysis and visualization of data generated at various levels and, alongside the HAT Strategic Information (SI) team, coordinates the Health Informatics Community of Practice tasked with the development of software solutions to meet the program management and reporting needs of the end-users, IPs whilst meeting international standards.

TimelineSubmission due date: April 1, 5pm Abuja time

Proposal review and contracting period: April 2-15 (estimated)

Expected contract start date: April 15

Expected field work timeline: April 26-May 7

Expected timeline for field work: April 15-June 30

Scope of Work and StandardsThe local subcontractor will be responsible for the following Scope of Work:

1. Hiring staff. Hire and make available the data collection supervisors, and data collectors, and drivers and vehicles. The DQA will require teams of data collectors comprised of supervisor/team leads, and data collectors. The bidder should propose an appropriate staffing make-up to complete field work in 14 days or less.

2. Preparing for field worka. The contractor will develop a Field Manual for data collectors and supervisors (different

sections for each type of staff), that supports efficient field work. The field manual should detail quality assurance processes. The Field Manual should be available prior to the Training.

b. The contractor will develop electronic version of the data collection tools (shared by Palladium/Data.FI) prior to the training. These will be revised as needed by the contractor following the pilot test.

c. The contractor will be responsible for developing a DQA field implementation plan that coordinates all logistics and personnel. This includes mapping out identified sites, determining efficient team assignments and planning transportation, accommodation and site visits in collaboration with Palladium/Data.FI.

d. Provide transportation for data collectors including fuel and drivers, during the pilot and data collection (field work). All vehicles to be used for fieldwork must be roadworthy and meet essential safety requirements.

e. Participate in a kick-off meeting with USAID implementing partners, subject to this DQA. 3. Training field workers and piloting tools.

a. Data collectors and supervisors will be required to participate in a 4-day DQA assessment training workshop (including pilot test). The contractor will be responsible for the logistics of organizing the training including providing the facilities, providing water, lunch, and snacks and any other necessary training supplies. The contractor will also be responsible for daily salary, per diem, hotel if necessary, and transport to and from the training facility for all contractor staff during the training. The contractor will also facilitate the training but will be co-facilitated with Data.FI staff and does not require development of any new training materials.

b. As part of the training, the contractor must organize a pilot test of the tools in a location near or within the Federal Capital Territory and will work with Palladium/Data.FI to update the tools and data collection process based on the pilot.


5. Conducting field work

a. Implement the DQA field work including data verification at the facility levelb. The contractor will update Data.FI/Nigeria on progress during field work on a daily basis. It

is expected that data collection supervisors will maintain telephone and/or email contact with the broader DQA team and any problems identified will be reported and corrected immediately

6. Compiling data and documenting experience

a. Write a brief report summarizing field experiences. A template will be provided by Data.FI.b. Provide all DQA data and field work monitoring forms to Data.FI/Nigeria, in the manner

agreed.

7. Dissemination:

a. Support preparations for and participate in a debrief presentation of preliminary findings on-site to the implementing partners participating in the assessment.

b. Review the final DQA report.

Palladium/Data.FI will provide oversight through a technical team. At least one Palladium/Data.FI team member will accompany the contractor’s field teams during data collection and co-facilitate debrief sessions.

Deliverables 1. CVs of data collectors and supervisors2. Field work planning documents including Manual describing field process and quality assurance

measures with components for both data collectors and supervisors, a data management plan that outlines data protection mechanisms, a field work timeline, and staff/team assignments

3. Training of DQA team4. End of fieldwork feedback report (template to be provided by Palladium/Data.FI)5. Participation in dissemination activities outlined in scope of work 6. Soft copies of all DQA tools used in the field with populated data

Data Protection and Ownership Data collected under this Agreement by the Contractor shall be treated as sensitive data and protected with adequate security measures according to the security guidance provided by Palladium/Data.FI. The Contractor may be required to sign Data Sharing Agreements with the IPs subject to the DQA. All data collection forms and data sets should be transferred to Palladium/Data.FI for storage and analysis at the end of the period of performance.

The Contractor agrees that the data collected under this contract belongs to Palladium/Data.FI and that the Contractor is prohibited from using, analyzing, or publishing the data collected under this Agreement without prior approval from Palladium/Data.FI. At the end of the period of performance, the Contractor must transfer all data collected and furnished under this Agreement to Palladium/Data.FI.


INSTRUCTIONS TO APPLICANTS Proposals should be no more than 10 pages, excluding attachments. The following items are required to be submitted as part of the proposal:

Technical Proposal (suggested outline provided below)

Past Experience Information/Capability Statement

Personnel CVs (not included in page limit)

Commitment Letters from Key Personnel (not included in page limit)

Past Performance References (template provided; not included in page limit)

Attachments

Please review the additional documentation and proposed contracts terms and conditions which should be given consideration when preparing your proposal. By submitting your bid you will certify that that you are in agreement with the contract terms and conditions as included in this solicitation and that all prices include all aspects of the required compliance with the terms and conditions of the proposed contract.

Past Performance Reference Format

Due diligence form(s)

Technical Proposal Requirements TECHNICAL APPROACH

The bidder should outline their approach to the work and their understanding of the scope. This section should include detail on quality assurance procedures including effective and secure data management.

As part of the Technical Approach, provide a Gantt Chart as an appendix that shows phasing of the tasks involved. The timeline does not count toward the page limit. The successful applicant will be expected to commence work from April 15, 2021 for DQA activities and submit all the required deliverables by June 30, 2021. Note that all field work must be completed by May 7 , 2 021 at the latest.

STAFFING AND MANAGEMENT PLAN

The applicant should propose at least one key staff – the Team Lead. The CV/resume of the Team Lead must be included in the application (CVs are not included in the page limitation). The Team Lead must have the following qualifications:

Bachelors’s degree; Masters degree preferred At least 3 years of experience managing complex field work Experience conducting field work for a DQA, strongly preferred Excellent communication skills Highly organized with strong attention to detail

The data collection will require field teams including a team supervisor and data collectors who must be available full-time during fieldwork and who must be able to travel. All data collectors must have at least a bachelor’s degree or equivalent in a relevant field, possess relevant experience and be proficient in English. Data.FI/Nigeria will verify curriculum vitae of all data collectors prior to fieldwork commencement. Ideally, there should be a gender balance of data collectors.

All data collection supervisors must have a university degree and will be proficient in English. Data.FI will verify curriculum vitae of all supervisors prior to fieldwork commencement. Supervisors will preferably be regular staff members of the contractor, rather than locum or short-term hires. Ideally at least one supervisor will be female.

Describe how the organization will staff and/or recruit for the relevant positions. If you propose current staff for any of these positions, please list the names and proposed position(s); their resume/CV may be


included as attachments to your proposal. Qualifications for field team members are noted in the scope of work above.

The project requires sending field teams out for data collection in several regions. Describe how you will ensure logistics support, maintain communications, liaise with organizations being assessed for their cooperation, and resolve unanticipated problems if/when they arise.

ORGANIZATIONAL CAPACITY AND EXPERIENCE

Describe the organization’s experience in implementing and managing projects that require substantial data collection and management of field work. Experience managing field teams to collect data at multiple sites simultaneously while maintaining data quality is particularly relevant. Describe the organization’s experience in designing and/or conducting in-depth interviews, focus group discussions, and/or the equivalent with organizational staff. Describe the organization’s experience in developing digital data collection tools and implementing field work using electronic data capture.

Use the template provided (Appendix 1) to provide past performance information about your organization, for up to five recent projects.

BUDGET

Using the template below, please provide a budget and narrative for all costs. The budget is not counted towards the maximum 10-page application length.

The budget should be organized by deliverable. We suggest one Excel workbook with a separate tab for each deliverable. Administrative and management costs should be built into each deliverable, and not costed separately. Please include a summary tab showing the entire budget, by deliverable. The budget should be broken down by the following cost categories: labor/salaries, travel, and other direct costs (e.g., workshop costs). The budget must be accompanied by a narrative (a Word/PDF document) that describes costs included.

The Contractor will collect data from select projects in select states, to be determined prior to contracting. For budget presentation purposes, applicants should assume that field work will be collected across 6 states from 26 facilities (per the table above). Field work should be completed in 14 days. The local subcontractor will be responsible for all associated costs of the data collectors and supervisors during the activity including coordinating lodging, transport, salary, and per diem.

Palladium/Data.FI anticipates awarding one fixed-price contract for all costs, including overhead rates for management fees.

Submission Information Proposals must be received no later than April 1st, 2021 by 5pm Nigeria time, in digital form as described below. Late submissions will not be considered except at the discretion of Palladium/Data.FI.

Electronic proposal shall be submitted as a Word Document or PDF document. Subject lines must be marked with “RFP-DQA-Nigeria-01”Offerors should submit their application package to Joshua Segalewitz ([email protected] ). The application package should include the following:

1. Technical proposal meeting the criteria2. CVs for all the core staff3. Timeline4. Budget

Questions or requests for clarifications regarding this solicitation should be received no later than March 26th at 5.00 P.M Nigeria time, via e-mail. No questions or request for clarifications will be accepted after this date. Answers will be posted in the same location as the original RFP.

Send questions to: Joshua Segalewitz ([email protected])

Palladium/Data.FI reserves the right to ask questions of clarification and/or request best and final offers from all or some of the applicants, in response to proposals.




Evaluation Criteria Past performance, relevant technical experience, cost, organizational capacity and other factors will be evaluated and the award will be made on the basis of best value to the U.S. Government. Technical factors are considered more important than cost factors.

Award is subject to the availability of funds. Offers submitted in response to this RFP (including prices, terms, and resources) must be valid for a period of at least 60 days from closing date of the RFP.

(a) The criteria below are presented by major category, with relative order of importance, so that applicants will know which areas require emphasis in the preparation of proposals. The sub-factors are considered equally important. The criteria below reflect the requirements of this particular solicitation.

(b) Even though cost has been assigned a numerical weight, applicants are reminded that Palladium/Data.FI is not obliged to award a negotiated contract on the basis of lowest proposed cost, or to the applicant with the highest technical evaluation score. Although for this procurement technical proposal merits are considered more important than cost relative to deciding which organizations might best perform the work, cost factors and Palladium/Data.FI’s budget must also be considered. Therefore, after the final evaluation of proposals, Palladium/Data.FI will make the award to the applicant whose proposal offers the best value to the Government considering both technical and cost factors.

Applicants should note that the following criteria: (1) serve as the standard against which all proposals will be evaluated, and (2) serve to identify the significant matters which applicants should address in their proposals. Refer to the table below for evaluation criteria.

Element Criteria Points

Organizational capacity and past performance

Experience in implementing and managing data quality assessments or similar type of activities requiring field teams to collect data at multiple sites while maintaining data quality.

Demonstrated success in completing project deliverables within time and budget

Experience working with USAID and/or PEPFAR partners in Nigeria

Experience with programming and using digital data collection tools

25

Technical approach

Demonstrated understanding of the DQA methodology Demonstrated understanding of the requested activities and

deliverables and the steps required to accomplish them Concise description of how the work will be carried out

including planning and preparations Explanation of how data will be collected/managed Demonstrated understanding of the staffing and logistics

requirements for field data collection and explanation of how they will be accomplished

Clear plan to mobilize quickly to meet timelines and realistic timeline considering that data must be provided to Palladium no later than May 7, 2021

25

Staffing and management

Demonstration of staffing needs and a plan for meeting them Qualifications of the proposed staff Clear and realistic organizational structure and lines of

supervision/reporting Understanding of the management challenges and experience-

based, practical strategies for addressing them Administrative and management tools and processes that will be

employed to ensure the delivery of high-quality and timely

25


Cost Alignment of the budget and proposed costs with the proposed activities and the deliverables

Realistic estimates of unit costs Reflection of strategies used to control costs and maximize

costs savings

25

Total 100

Palladium reserves the right to award under this solicitation without further negotiations. The offerors are encouraged to offer their best terms and prices with the original submission.

PROCUREMENT INTEGRITY AND ETHICSIt is Palladium’s Policy that no gifts of any kind and of any value be exchanged between vendors/contractors and Palladium personnel. Discovery of the same will be grounds for disqualification of the vendor/contractor from participation in any Palladium’s procurements and may result in disciplinary actions against Palladium personnel involved in such discovered transactions.


TERMS AND CONDITIONSDURATION OF OFFERS

Offers submitted in response to this RFP (including prices, terms, and resources) must be valid for a period of at least 60 days from closing date of the RFP.

PROPOSED CONTRACT TYPE

Palladium/Data.FI anticipates awarding a Firm Fixed Price subcontract with deliverables to one or more offerors. Prices submitted should be all inclusive and final for performance of the stated scope of work.

NEGOTIATIONS

The applicant’s most competitive proposal is requested. It is anticipated that subcontracts will be awarded on the basis of these proposals. However, Palladium/Data.FI reserves the right to conduct negotiations prior to awarding a subcontract.

REJECTION OF OFFERS

Palladium/Data.FI reserves the right to reject any and all offers, if such action is considered to be in the best interest of the Government.

INCURRING COSTS

Issuance of this solicitation does not in any way obligate Palladium/Data.FI to award a contract nor does it commit Palladium/Data.FI to pay for costs incurred in the preparation and submission of a proposal.

ACCEPTANCE OF CONDITIONS

Palladium/Data.FI reserves the right to request additional information from applicants in writing. Palladium/Data.FI may cancel this RFP without any cost or obligation at any time until the execution of a subcontract. In the event agreement cannot be reached with the awardees, Palladium/Data.FI reserves the right to award an alternate applicant.

Any contract/purchase order resulting from this solicitation must be signed by both parties in order to be considered valid and in force. All costs associated with, but not limited to, production, preparation and/or delivery of goods or services, including deliveries, accepted by Palladium staff, without a fully executed (signed by both parties) contract/purchase order, are at the vendor’s risk only. Palladium shall not pay for any costs, without limitation, associated with production, preparation or delivery of goods and/or services under this or any other contract/purchase order, which has not been signed by both parties.

If your proposal is successful, you will be required to enter into the Company’s standard contract for the types of goods or services being provided. In the provision of the Goods and Services, you will be required to comply with the Company’s policies, including (without limitation) its Business Partner Code of Conduct and any relevant client terms and conditions. Potential suppliers must also comply with the Company’s Business Partner Code of Conduct in the submission of any proposals pursuant to this RFP.

If you are bidding as part of a joint venture, partnership or similar, please make this clear in your submission. Likewise, if you propose to subcontract any part of the goods or services provision, then disclose this fact within your submission. The Company may require additional information from you and approval for subcontracting will not be automatic as subcontractors will be subject to Palladium’s Due Diligence process and USAID approval.

CONFIDENTIALITY/OWNERSHIP

The awardees and his/her employees will not at any time, either during the term of the subcontract or thereafter divulge, furnish or make available, either directly or indirectly, to any person, firm, corporation or other entity, any proprietary information used by Palladium/Data.FI. The awardees agree that all such matters and information shall be kept strictly and absolutely confidential. The awardees, upon cessation of the subcontract, irrespective of the time, manner or reason of terminations, will immediately surrender and deliver to Palladium/Data.FI all material and data of every kind belonging to Palladium/Data.FI. The release of any information and data obtained through the execution of the subcontract must be explicitly approved in writing by Palladium/Data.FI.

APPENDIX 1 : PAST PERFOMRANCE INFORMATION TEMPLATE

Past Performance Information

1. Title

2. Name of client/donor 3. Address of client/donor

4. Contract number or other reference

number:

5. Date of contract

6. Date work began 7. Date work completed

8. Contract amount in USD9. Technical point of contact (name, address,

telephone, email)

10. Contractual/ financial point of contact

(name, address, telephone, email)

11. Location of work (country, state, province, district, city)

12. Description of work (nature and scope). Use continuation sheet if needed.

13. Current status of contract (choose one):□ Work continuing, on schedule □ Work completed, claim negotiations pending

or underway□ Work continuing, behind schedule □ Work completed, litigation pending or

underway□ Work completed, no further action pending

or underway

□ Terminated for convenience

□ Work completed, routine administrative

action pending or underway

□ Terminated for default

□ Other (explain)


Instructions for Completing the Past Performance Information Sheet1. Insert the complete name of the client, including parent organization, if any. Do not use

acronyms.

2. Insert the client’s complete address, including both post office box and street address, if applicable.

3. Insert the contract number or other contract reference used by the client.

4. Insert the date on which the contract came into existence.

5. Insert the date on which you started to perform the work.

6. Insert the date on which the client agreed that the work was satisfactorily completed (including substantial completion), aside from any pending or on-going administrative actions, claims negotiations, or litigation.

7. Insert the contract amount, in US dollars.

8. Insert the name, title, address, telephone no., and e-mail address (if available) of the program or project manager, quality assurance representative, or other client technical representative who is most familiar with the quality of your work under the contract.

9. Insert the name, title, address, telephone no., and e-mail address (if available) of the contracting officer, purchasing agent, or other client contracting or purchasing representative who is most familiar with your work under the contract.

10. Insert the location(s) where the work was performed, including the country and the state or province, county (if applicable), and city.

11. Describe the nature and scope of the work. The objective is to show how the work that you did or are doing is similar in nature and scope to the work that is to be performed under the contract contemplated by the request for proposals. Describe any unusual circumstances of performance or problems that may be relevant to the work that is to be performed. Tell your side of the story of any conflicts with the customer concerning which they may make adverse remarks about your performance. Describe any actions that you have taken or plan to take to correct any shortcomings in your performance. Describe any pending, on-going, or completed litigation.

12. Insert an X in the block next to the choice which best describes the current status of the contract. If you select the “Other” block, provide a brief explanation.

Appendix 2. Due diligence form

Please provide answers to and information regarding all of the questions below. For any answer requiring more space than is given in this form, please attach the complete answer on a separate sheet. To the extent permitted by law, all information provided in this form will be held in confidence and not disclosed to any third parties without prior notice and approval.

Part 1 Identifying information

Part 1 a

To be completed if an organisation is the subject of Due Diligence

Name of organisation: ...

Organisation headquarters address/main office: …

Country or countries where activities will take place: …

Website for organisation: …

Name of owner/managing director for organisation: …

List any former name(s) owner/managing director for organisation:

…

Part 1 b

To be completed either if an individual is the Subject of Due Diligence or, if an organisation is the Subject of Due Diligence, then to be filled out by the owner/managing director of the organisation

Full Legal Name (As written on passport or national identification card)

…

Home address for individual or owner/managing director, phone number, and email address:

…

Identify card / Passport: …Nationality: … Date of birth: dd/mm/yyyyTelephone: … E-mail: …

Part 2 Business information

( Only applicable if an organisation is the Subject of Due Diligence. For individual move to part 4)

To be completed by the owner/managing director

a Sole Proprietorship ☐ Partnership ☐ Corporation ☐ Non Profit ☐ Other ☐


If other, please specify below:

…

b Is this organisation registered? If so, please note the country and registration number below

☐ Yes ☐ No

…

d Is the entity an organisation listed on a public stock exchange? If so, please provide relevant details below.

☐ Yes ☐ No

…

e If applicable, please list any parent companies or subsidiaries below:

…

Does any Public Official or government entity have any financial, management or controlling interest in your organisation? If so, provide details and level of interest below.

☐ Yes ☐ No

…

Please list the full names and date of birth of all Principals for your organisation. (Note: the term “Principal” includes, but is not limited to, the executive officers, partners, owners, directors, trustees or others who exercise control over your organisation).

…


Part 3 Compliance, health and safety

Does the organisation have an institutionalized Financial and internal controls policy? If so, please attach or provide details below.

☐ Yes ☐ No

…

Does the organisation have an occupational health and safety (OHS) policy? If so, please attach or provide details below.

☐ Yes ☐ No

…

Please state whether the organisation meets the legislative requirement of compulsory insurance where business will take place and please attach the certification or provide details by country or countries.

…

Part 4 Government relationships

To be completed by the individual or owner/managing director of the organisation

Please state whether:

You are currently, or have been during the last two years, a Public Official (as that term is defined in Part 7 below)

Yes ☐ No ☐

Your organisation employs a current Public Official (If applicable)

Yes ☐ No ☐

You are a close relative (i.e. mother, father, sister, brother, spouse or child) of a Public Official

Yes ☐ No ☐

Any Principal of your organisation has a close relative who is a Public Official (If applicable)

Yes ☐ No ☐


For any person identified as a close relative above, please provide their name (surnames and given name), title, relationship to you or the organisation, and responsibilities for the government, agency, or government controlled enterprise or company. If additional space is needed, attach a separate sheet of paper.

…

Part 5 Prior conduct


Have you (or any Principals of your organisation) ever been investigated for, charged with, convicted or otherwise implicated in criminal, corrupt, unethical, or unlawful conduct?

Yes ☐ No ☐

(If applicable) Has the organisation, or any subsidiary or affiliate of your organisation ever been investigated for, charged with, convicted or otherwise implicated in criminal, corrupt, unethical, or unlawful conduct?

Yes ☐ No ☐

(If applicable) Has the organisation ever been issued a sanction or committed a violation of law or regulation?

Yes ☐ No ☐

If yes to any of the above, please describe the circumstances below:

…

Part 6 Additional disclosures


Please provide any additional information below that would assist the company in performing its due diligence review. If more space is needed, attach a separate sheet.


…

Part 7 Certification


CertificationI hereby certify that:

To the best of my knowledge, all information in this response is truthful, correct and complete;I have read the information at the websites noted below and I am familiar with the requirements of these anticorruption statutes:

UK Bribery Act 2010 ;

Australian Criminal Code ;

U.S. Foreign Corrupt Practices Act ;

I have read the definition of Public Official below and declare that neither I, nor any of my immediate family members, are Public Officials, except as previously disclosed.

I have never paid, approved for payment or otherwise provided, directly or indirectly, anything of value to a Public Official for any improper, corrupt or illegal purpose, nor will I; and I have never created a false invoice or otherwise manipulated documentation to disguise making a payment or otherwise providing anything of value to a Public Official for any purpose, nor will I.

NOTE: “Public Official” means any person, whether elected or appointed who holds an executive, legislative, administrative or judicial office or position in any public entity, including any international agency. In addition, “Public Official” includes any person who performs public functions in any branch of the national, state, local or municipal government of any country or territory or who exercises a public function, by employment or under contract, for any public entity, agency or enterprise of such country or territory, including state owned or controlled enterprises, or any part of a government. The definition of “Public Official” also includes any official of a political party or any candidate for political office.

I further hereby acknowledge that I have reviewed the Business Partner Code of Conduct and I, and/or my organisation, will comply with all requirements set out in such Code.

Data Collection NoticeIf you are completing this form for yourself as an individual, then you acknowledge the following. If you are completing this form for an organisation (whether a company, trust, charity or similar), you acknowledge that you have obtained consent to the following from the relevant individuals.

Palladium is committed to the protection of personal information and compliance with relevant data protection and privacy laws. The information requested by this form is collected directly from you to assess your suitability, or that of a relevant individual, to provide services to Palladium, its clients and/or any of its


http://thepalladiumgroup.com/policies

http://www.justice.gov/criminal-fraud/foreign-corrupt-practices-act

https://www.comlaw.gov.au/Details/C2004A00730

http://www.justice.gov.uk/downloads/legislation/bribery-act-2010-guidance.pdf

projects. The information we will collect pursuant to this due diligence exercise is as outlined in this form, but we may also obtain information through an investigative report, which may draw on public registers, interviews or public media. We collect this information on the legal basis of your consent, and then will later use it for the performance of any contract with you or for the performance of any relevant contract with our clients.

This information may be shared with any of Palladium’s related companies or relevant clients where such sharing is a) required by a relevant law, our contract with you or with our clients; or b) permitted by a relevant data protection law. Where sharing is with related companies, such related companies will comply with Palladium data protection guidelines.

This information may be provided to our offices/related companies overseas, subject to such overseas offices/related companies being bound by the same data protection standards as the office or company to which you provide the information and provided also that such transfer of information is required as part of fulfilling the purpose of or reasons for the provision of the information, or for the performance of any subsequent contract. An example of this might be that the relevant decision maker or individual involved in the decision is based in another location. Further details are available at http://thepalladiumgroup.com/legal/our-policies.

The information you provide will be used to a) make an informed assessment about whether Palladium can enter into an agreement with you or your organisation, b) manage your contract and services with Palladium in the event we enter into an agreement with you, or c) assess certain internal diversity and inclusion metrics. If you do not provide your data or consent to processing by us then we cannot assess your suitability to enter into a contract with you.

Depending on your country of residence, you may have certain data protection or privacy rights. You can find details, including our retention guidelines, at http://thepalladiumgroup.com/legal/our-policies. Privacy or data protection queries can be directed to [email protected]

Signature:

Name: …

Title: …

Date: …



http://thepalladiumgroup.com/legal/our-policies

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